RN / Medical Management Nurse
Posted on: December 4, 2019
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
- 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
- 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
- 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
- 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
- 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
- Maintains billable hours appropriate to role and assigned
- Must be able to work at least 40 hours per week, Monday thru
Friday and be available to work extended hours as situations
- Negotiation skills are necessary to establish and facilitate
- 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
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