Registered Nurse - Workers' Comp Utilization Review Case Manager (Hybrid - Remote/In-Office)

The County of Riverside's Department of Human Resources is seeking a permanent Registered Nurses (RN) for the Workers' Compensation Utilization Review Nurse Case Manager position to support the County's Human Resources Workers' Compensation Division. The most competitive candidates will have knowledge of CA MTUS, ACOEM,ODG and RFA's. Recent Registered Nurse experience with Utilization Review for a Workers' Compensation Department or self-insured program is highly preferred. Additional Pertinent Information:

• 9/80 work schedule.
• This position offers the opportunity for remote work, with a hybrid schedule requiring 2 days in the office each week.
• In office during training from 8:00am - 5:30pm

Meet the team! The Human Resources Department strives to effectively serve and partner with our community, departments and employees by leveraging best practices and innovation to foster a thriving county.• Assesses, plans, implements, coordinates, monitors and evaluates medical services, utilization review and return to work options for injured employees; is a department resource for medical inquiries, claim file reviews, and utilization review.

• Provides medical, behavioral/motivational, occupational, and economic management activities for employees with work related injuries and provides early medical management intervention for new injuries, consulting on medical only and lost time injury files and utilization review on all requests for medical treatment.
• Evaluates health care services of requesting physicians based on the appropriateness of the service and the level of care at which this service would be delivered; is a neutral advocate for employees.
• Performs utilization review in concert with the utilization review physician to approve, delay, modify, or deny treatment.
• Performs medical reviews on Workers' Compensation claims and provides recommendations which are preemptive, focused on moving the injured employee along the healing continuum, return to work opportunities, and employer protection.
• Applies clinical expertise as a resource to the adjuster, employee, and the employer to identify the best results while coordinating the appropriate resource utilization; identifies and manages patient problems to eliminate duplication and fragmentation of health cares service.
• Assists in the development of policies and procedures, standards of care and practice, and in the monitoring of those standards to ensure regulatory compliance, as required by the Division of Workers' Compensation and the Department of Insurance.
• Promotes collaboration among other departments, programs, physicians; represents the Workers Compensation Division when needed in business meetings.OPTION I

Experience: Five years full-time RN experience in a Managed Care or Occupational Health setting to include experience in Workers' Compensation and Utilization Review. OPTION II Education: A bachelor's Degree in Nursing, Health Related discipline or Education. Experience: Three years of experience in Workers' Compensation and Utilization Review. Possession of a valid California State Public Health Nursing Certificate. OPTION III Education: A Master's Degree in Nursing, Health Related discipline or Education. Experience: Two years of experience in Workers' Compensation and Utilization Review. Other Requirements (All) License/Certificate: Must possess and maintain a current valid license to practice as a Registered Nurse in the State of California. Must possess and maintain a current Case Manager Certificate. A valid California driver's license may be required. Knowledge of: Workers' compensation and utilization review principles and practices; managed care and occupational health issues and standards; application of the nursing process; full range of registered nurse duties and responsibilities; principles and methods of supervision and training; basic management skills; problem solving techniques. Ability to: Plan, organize, supervise and evaluate nursing services on specific unit(s); communicate effectively; positively manage change and conflict; interpret licensure and accreditation standards; analyze and draft department policies and procedures; apply productive problem solving skills; write clear and concise reports; perform registered nurse or public health nurse responsibilities according to the State of California Nurse Practice Act; implement the nursing process.For further information regarding this posting, please contact Denise Decamp, ([email protected]) Remote About the Company: County of Riverside The County of Riverside offers an aray of professions, careers, and opportunites within over 40 diverse departments California's fourth largest county by population is expanding its economy, working to make Riverside County as business-friendly as possible and using health and recreations strategies to make the county a healthier place for residents. Each year, millions visit the county to take advantage of the glorious desert winter, attend the Riverside County Fair and National Date Festival, the Balloon and Wine Festival, the Palm Springs International Film Festival, the Coachella and Stagecoach mega-concerts, the Paribas Open at the Indian Wells Tennis Center and the Humana Challenge, the golf tournament formerly known as the Bob Hope Classic. All those, combined with a rich cultural heritage and frontier history, make Riverside County a great place live, work, and play. With rivers, mountain peaks, deserts and fertile valleys, Riverside County offers diversity that few locations can match. More than two million people live in Riverside County, taking advantage of affordable housing, nearby beaches, mountains, hiking and bike trails, the Wine Country near Temecula and resorts that offer oases in the desert. Company Size: 10,000 employees or more Industry: Government and Military Founded: 0 Apply tot his job Apply To this Job