FresnoRecruiter Since 2001
the smart solution for Fresno jobs

RN / Medical Management Nurse

Company: Risico
Location: Fresno
Posted on: July 13, 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 desirableAchieves 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 CoverageDental Reimbursement401 (k) with Employer MatchHoliday PayVacation/ Sick PayPaid "flex" day per monthPaid Birthday offRelaxed Dress CodeHealth Spending AccountEmployee and Dependent life insuranceDisability InsuranceSection 125 - FSAAppointment 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 authorizationOn 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 responsibilityResponds 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 caseConsistently 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

Other Executive Jobs

Business Manager - RCCB
Description: Position Summary:As a key member of the management team, the Business Manager must ensure compliance with all company policies and procedures while using analytical skills to be a resource to the Distribution (more...)
Company: Reyes Coca-Cola Bottling
Location: Fresno
Posted on: 07/18/2019

Director for Employer Connections & Internships
Description: Director for Employer Connections Internships br br Job Category: br br Managerial/Professional br br Unit: br br Center for Career and Professional Advancement br br Position Code: (more...)
Company: University of California - Merced
Location: Merced
Posted on: 07/17/2019

Restaurant Manager
Description: Panda Express managers can have the opportunity to embody an entrepreneurial spirit while learning from a very hands-on and fast-paced environment. As a General Manager, you will be in charge of a 1-2 (more...)
Company: Panda Express
Location: Modesto
Posted on: 07/17/2019

Sales Manager, In Home Design - Market 8 (Fresno)
Description: Sales Manager, In Home Design - Market 8 Fresno Brand Best Buy Our Manager, In-Home Design Sales is the single point of contact for all In-Home Design consultations and projects. They will spend the (more...)
Company: Best Buy Co
Location: Fresno
Posted on: 07/17/2019

Fresno Apartment Community Director
Description: FPI Management is currently looking for a Community Director to join our team OUR IDEAL CANDIDATE has experience in an Apartment Manager role. Is a dynamic leader, possessing the ability to motivate (more...)
Company: FPI Management
Location: Fresno
Posted on: 07/17/2019

College Graduates - Tutor Director - REMOTE
Description: About the RoleWe are looking for a full-time Tutor to start or grow a tutoring business within the Clark network. You will have a chance to work with our team of experts to build a scalable tutoring business (more...)
Company: Clark
Location: Merced
Posted on: 07/17/2019

Market Manager
Description: Is it your goal to run your own business and be a strong presence in your community and beyond Do you thrive in an environment that empowers you to make decisions and create a winning culture br As (more...)
Company: ManpowerGroup
Location: Fresno
Posted on: 07/18/2019

Deputy Project Manager
Description: Deputy Project Manager This is your opportunity to join one of North America's leading transportation and infrastructure contractors, building some of the most complex and noteworthy projects in the U.S. (more...)
Company: Flatiron
Location: Fresno
Posted on: 07/18/2019

Automotive Tool Sales / Route Manager - Full Training
Description: Build a Great Career and a Great Life.Automotive Job title: Automotive Tool Sales / Route Manager - Full TrainingFeel the freedom independence of managing your own protected route selling our National (more...)
Company: Mac Tools
Location: Ceres
Posted on: 07/18/2019

11B Infantryman - Management Training
Description: 11B Infantryman - Management TrainingJob ID: Job Views: 315Location: VISALIA, California, United StatesZIP Code: 93291Job Category: InfantryPosted: 05.29.2019Age Requirements: Must be between the ages (more...)
Company: Army National Guard
Location: Visalia
Posted on: 07/17/2019

Log In or Create An Account

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

Fresno RSS job feeds