Industrial Rehabilitation Nurse (PN 20082495)

State of Ohio • Columbus, OH

1d • Onsite

About The Position

Responsible for completing assigned nurse referral tasks for clinical recommendations that are supported by the medical information based on critical decision making for\: initial allowance(s), additional allowance(s), physician review/exam referrals, quality assurance reviews, ICD-10 coding and description modification requests, and special medical functions for death claims, permanent and total disability claims, etc. Reviews and analyzes subjective and objective evidence for medical indicators to determine if they were caused and/or have not been caused by the work place injury/illness; identifies and reports claims situations where further clarification and/or development of medical evidence is required; and identifies claims situations where there is a need for physician review or exam. Serves as clinical subject matter expert on BWC medical service specialist (MSS) policies and procedures to internal and external parties to the claim and performs related duties as required. Maintains data tracking processes and adheres to timeliness and quality standards for work performed; participates in quality reviews as assigned. Participates in problem solving for medical or claim barriers by collaborating as part of a multidisciplinary team with BWC Claims, Managed Care Organization (MCO), injured worker, employer, and/or providers for optimal claim outcome for recovery and return to work (if feasible).

Requirements

• Current & valid license to practice professional nursing as Registered Nurse (i.e., R.N.) in Ohio as issued by Board of Nursing pursuant to Section 4723.03 of Ohio Revised Code
• 6 mos. exp. as licensed Registered Nurse
• Knowledge of nursing; federal & state laws; BWC policies & procedures; case management strategies; ICD & ICDM codes; interviewing; public relations; medical techniques, procedures, & definitions; employee training.
• Ability to: interpret diagnoses, assess limitations & write accurate medical reports based on claim data; read & comprehend medical charts, manuals & journals; medical policy & guidelines; handle routine inquiries from & contacts injured workers, employers, physicians, attorney’s, government officials, providers, or representative & general public; independently review medical bills to analyze costs & deem appropriateness; explain medical policy & guidelines; prepare & deliver speeches before specialized audiences & general public.
• Background Check & Drug Test
• Transportation: Position may require travel; therefore, persons occupying this position must be able to provide own transportation &/or legally operate a state-owned vehicle.

Responsibilities

• Completing assigned nurse referral tasks for clinical recommendations
• Reviews and analyzes subjective and objective evidence for medical indicators
• Serves as clinical subject matter expert on BWC medical service specialist (MSS) policies and procedures
• Maintains data tracking processes and adheres to timeliness and quality standards for work performed
• Participates in problem solving for medical or claim barriers

Benefits

• Medical Coverage
• Free Dental, Vision and Basic Life Insurance premiums after completion of eligibility period
• Paid time off, including vacation, personal, sick leave and 11 paid holidays per year
• Childbirth, Adoption, and Foster Care leave
• Education and Development Opportunities (Employee Development Funds, Public Service Loan Forgiveness, and more)
• Public Retirement Systems ( such as OPERS, STRS, SERS, and HPRS ) & Optional Deferred Compensation ( Ohio Deferred Compensation )

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed