Temporary Registered Nurse – Workers' Comp Utilization Review Case Manager

County of Riverside; California; Hybrid; USD 70,000 - 95,000; Full time

Job summary

Join a forward-thinking organization as a Temporary Registered Nurse specializing in Workers' Compensation Utilization Review. In this role, you'll assess and coordinate medical services for injured employees, ensuring they receive appropriate care and support. The ideal candidate will have a strong background in utilization review and managed care, along with the ability to communicate effectively and draft policies. This position offers a hybrid work schedule, allowing for flexibility while contributing to the well-being of employees. If you're passionate about making a difference in the lives of others, this opportunity is perfect for you.

Qualifications

• 5 years RN experience in Managed Care or Occupational Health.
• Valid California RN license and Case Manager Certificate required.

Responsibilities

• Assess and coordinate medical services for injured employees.
• Evaluate healthcare services and perform utilization review.
• Develop policies to ensure compliance with regulations.

Skills

Utilization Review

Workers' Compensation

Managed Care

Nursing Processes

Problem Solving

Education

Bachelor's Degree in Nursing

Master's Degree in Nursing

Job description

Temporary Registered Nurse – Workers' Comp Utilization Review Case Manager

Join to apply for the Temporary Registered Nurse – Workers' Comp Utilization Review Case Manager role at County of Riverside.

Position Overview

The County of Riverside’s Department of Human Resources is seeking a Temporary Registered Nurse (RN) for the Workers' Compensation Utilization Review Nurse Case Manager position to support the County's Workers' Compensation Division.

The ideal candidate will have knowledge of CA MTUS, ACOEM, ODG, and RFA's. Recent experience with Utilization Review in a Workers' Compensation Department or a self-insured program is highly preferred.

Additional Information

• 9/80 work schedule.
• Remote work opportunity with a hybrid schedule (2 days in-office per week).
• In-office during training from 8:00 am to 5:30 pm.

Learn more about TAP: https://rc-hr.com/temporary-medical-assignment-program-tapmap

Benefits: https://rc-hr.com/files/users/user81/2024%20TAP%20Flyer.pdf

Essential Duties

• Assess, plan, implement, coordinate, monitor, and evaluate medical services, utilization review, and return-to-work options for injured employees.
• Provide medical, behavioral/motivational, occupational, and economic management activities for employees with work-related injuries.
• Evaluate healthcare services requested by physicians based on appropriateness and level of care.
• Perform utilization review in collaboration with physicians to approve, delay, modify, or deny treatment.
• Review Workers' Compensation claims and provide recommendations to facilitate healing and return to work.
• Apply clinical expertise to identify optimal resource utilization and coordinate care.
• Assist in developing policies, procedures, and standards to ensure compliance with regulations.
• Promote collaboration across departments and represent the Workers' Compensation Division when needed.

Minimum Qualifications

OPTION I: 5 years full-time RN experience in Managed Care or Occupational Health, including Workers' Compensation and Utilization Review.

OPTION II: Bachelor's Degree in Nursing or related field + 3 years of Workers' Compensation and Utilization Review experience. Must hold a valid California Public Health Nursing Certificate.

OPTION III: Master's Degree in Nursing or related field + 2 years of Workers' Compensation and Utilization Review experience.

Other Requirements

• Valid California RN license and Case Manager Certificate.
• Possession of a valid California driver's license may be required.

Knowledge & Skills

Understanding of workers' compensation principles, managed care, nursing processes, supervision, and problem-solving skills. Ability to plan, communicate effectively, interpret standards, and draft policies.

Additional Information

For questions, contact Brian Arcinas at [e-mail].