FresnoRecruiter Since 2001
the smart solution for Fresno jobs

RN / Medical Management Nurse

Company: Risico
Location: Fresno
Posted on: December 3, 2019

Job Description:

Risico Total Managed Care, Inc. (Risico) is seeking a qualified Medical Management Nurse to join the Risico Team in our Fresno office. We are very excited about the growth of our company and new areas of expansion. We are willing to train candidates in workers comp if they have the right qualifications and background. Qualifications, Education, Skills, Experience and Attendance Requirements: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Graduate of accredited Registered Nursing Program. Current unrestricted California RN license. BSN desirable. Strong clinical background in orthopedics, emergency room, intensive care, neurology, occupational medicine or rehabilitation useful. Strong cost containment background, such as utilization review or managed care also useful. One to two plus years of recent clinical experience and/or one to two years of recent managed care experience. Bilingual Spanish speaking skills desirable Achieves URAC- recognized certification in case management with four (4) years of hire We offer a competitive salary, excellent opportunities for growth and a comprehensive benefit package. Benefits are listed below; Medical Coverage Dental Reimbursement 401 (k) with Employer Match Holiday Pay Vacation/ Sick Pay Paid "flex" - day per month Paid Birthday off Relaxed Dress Code Health Spending Account Employee and Dependent life insurance Disability Insurance Section 125 - FSA Appointment Time ( non-exempt staff) Additional Optional Insurance Role and Responsibilities: These duties include but are not limited to; Conducts prospective, expedited, concurrent and retrospective reviews related to medical treatment requests for authorization On assigned case management cases, assesses severity of the injury, evaluates treatment plans and the extent of disability, and collaborates with all applicable parties in order to establish goals that facilitate a safe/timely return to work as well as to achieve maximum functional restoration for the injured worker. Ensure the privacy and security of Protected Health Information (PHI). Consistent and effective communication with injured workers, medical professionals, administrative assistants, claims staff, employers and all stake holders is a primary responsibility Responds to various written and telephone inquiries in a timely manner regarding the status of the case. Engages in the proper use of resources including the TMC Medical Director, Peer Review, various vendors and other applicable resources to achieve optimal outcomes on each case Consistently maintains confidentiality on any/all cases, professional, positive and appropriate communications, accurate documentation including goals, interventions, recommendations and decisions regarding assigned case management cases. Prioritizes and coordinates multiple responsibilities while working closely with internal and external customers. Document the use/source of evidence based guidelines utilized when performing a clinical review regarding requests for medical treatment authorization. Forwards to the Medical Director or clinical peer reviewer's cases which do not meet initial clinical criteria in the performance of utilization review. Medical Management Nurses do not issue denials. Document the use of best practice references such as standardized disability duration guidelines and medical management resources /references utilized while performing case management assessments, activities and interventions. Functions as a clinical resource to administrative assistants, claims staff, employers and injured workers. Reports any actual or potential quality issues or potential serious medical treatment concern issues to the VP/Director of Nursing, Utilization Review/ Medical Management Nurse Supervisor and/or Medical Director. Limited local travel may be required for occasional field/site visits. Maintains billable hours appropriate to role and assigned accounts. Must be able to work at least 40 hours per week, Monday thru Friday and be available to work extended hours as situations arise. Negotiation skills are necessary to establish and facilitate treatment. Perform other related duties as required. Maintain confidentiality, professional, positive and appropriate communications, accurate documentation including goals, interventions, recommendations and decisions regarding each case. Prioritize and coordinate multiple responsibilities while working closely with internal and external customers.

Keywords: Risico, Fresno , RN / Medical Management Nurse, Executive , Fresno, California

Click here to apply!

Didn't find what you're looking for? Search again!

I'm looking for
in category
within


Other Executive Jobs


Manager Customer Service
Description: Manager Customer Service California-Modesto Graybar is looking for talented, enthusiastic people to help us maintain the highest levels of customer satisfaction in every area of our business. We are a (more...)
Company: GRAYBAR ELECTRIC CO INC
Location: Modesto
Posted on: 12/8/2019

Grooming Salon Leader (Manager)
Description: Healthier pets. Happier people. Better world. Our vision might sound lofty, but we believe it s attainable when we obsess about providing complete care for our amazing pets. Our approach goes far beyond (more...)
Company: Petco
Location: Modesto
Posted on: 12/8/2019

Infantryman - Management Training
Description: Company: Army National Guard Contact: Post Date: 11/21/19 Phone: Job Type: Part Time Fax: Reference: CAUvoVAy8b Mailing Address: AGE REQUIREMENTS: Must be between the ages of 17 and 35The Infantry is (more...)
Company: Army National Guard
Location: Visalia
Posted on: 12/8/2019


Assistant Ranch Manager
Description: An established Modesto area, progressive farming operation is seeking an entry-level ASSISTANT RANCH MANAGER.
Company: BV Farms, LLC
Location: Modesto
Posted on: 12/9/2019

Telephonic Case Manager-Work From Home
Description: Study Management Associate III - Work from home Can be home-based anywhere in USA - Multiple openings
Company: The Career Hut
Location: Madera
Posted on: 12/8/2019

Digital Grassroots Manager
Description: Overview Are you ready to join an organization where you can make an extraordinary impact every single day Envision all Americans enjoying ideal cardiovascular health free of heart disease and stroke. (more...)
Company: American Heart Association
Location: Fresno
Posted on: 12/8/2019

Organizing and Engagement Manager, CA Tobacco Center
Description: Overview Are you ready to join an organization where you can make an extraordinary impact every single day Envision all Americans enjoying ideal cardiovascular health free of heart disease and stroke. (more...)
Company: American Heart Association
Location: Fresno
Posted on: 12/9/2019

Facilities Operations Manager
Description: Facilities Operations Manager needs 5 years of facility management or building operations experience required with 3 years of supervisory
Company: Global Channel Management, Inc.
Location: Modesto
Posted on: 12/8/2019

Search Engineering Manager
Description: Join Hired and find your dream job as a Search Engineering Manager at one of 10,000 companies looking for candidates just like you. Companies on Hired apply to you, not the other way around. You'll receive (more...)
Company: Hired
Location: Gilroy
Posted on: 12/9/2019

Telephonic Case Manager-Work From Home
Description: Study Management Associate III - Work from home Can be home-based anywhere in USA - Multiple openings
Company: The Career Hut
Location: Fresno
Posted on: 12/8/2019

Log In or Create An Account

Get the latest California jobs by following @recnetCA on Twitter!

Fresno RSS job feeds