Workers Compensation Utilization Review Nurse Case Manager (00113024)

The County of Riverside's Department of Human Resources is seeking a temporary and permanent Workers' Compensation Utilization Review Nurse Case Manager to support the County of Riverside Workers' Compensation Program.

The most competitive candidates will have knowledge of CA MTUS, ACOEM,ODG and RFA's.

Recent nursing experience with Utilization Review for a workers' compensation department or self-insured program is highly preferred.

Additional Pertinent Information:


* 9/80: In office during training from 8:00am - 5:30pm


* Opportunity for remote work.

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 Califor...