L&I Occupational Nurse Consultant/Health Services Analysis

State of Washington • Tumwater, WA

358d • Remote

About The Position

The Department of Labor & Industries (L&I) is a diverse state agency dedicated to the safety, health, and security of Washington's workers. We help employers meet safety and health standards and inspect workplaces when alerted to hazards. As administrators of the state's workers' compensation system, we are similar to a large insurance company, providing medical and limited wage-replacement coverage to workers who suffer job-related injuries and illness. Our rules and enforcement programs also help ensure workers are paid what they are owed, that children's and teens' work hours are limited, and that consumers are protected from unsound building practices. Insurance Services is the largest division within the agency and administers one of the premier workers' compensation organizations in the nation serving over 3.8 million employees working for 260,000 employers. Within Insurance Services the Health Services Analysis (H S A) program is looking for an Occupational Nurse Consultant. This opportunity is responsible for reviewing quality of care and risk of harm concerns in relation to healthcare providers and injured workers, and provides consultative services regarding these matters. The ONC also reviews and evaluates medical provider applications to determine eligibility to participate in the provider network. H S A's main function is to pay for medical services to treat injured workers and handle all aspects of the department's business relationships with the healthcare providers who provide those services.

Requirements

• Possess a valid Washington State license to practice as a registered professional nurse.
• Two years of consultative, administrative or supervisory experience over registered nursing staff or other healthcare professionals OR a Bachelor's degree in nursing from an accredited university/college.
• Three years of clinical or functional nursing experience OR a master's degree in a health care related field AND two years of clinical or functional nursing experience.

Nice To Haves

• Demonstrated computer skills - PC, LINIIS, Provider One, MIPS, Hyperion, ORION, and Microsoft Office.
• Two or more years of healthcare credentialing experience.
• Demonstrated knowledge of the Nursing Process and critical thinking.
• Demonstrated ability to communicate effectively verbally and in writing.

Responsibilities

• Review and evaluate medical provider applications.
• Assess provider quality of care and healthcare provider risk of harm concerns.
• Review provider complaints (referrals) sent to the unit from claims staff, department medical staff, injured workers, employers, etc., regarding medical necessary/quality of care issues.
• Confer with the Department of Labor and Industries Assistant Attorney General staff for matters brought before the Board of Industrial Insurance Appeals (BIIA) or other legal forum.
• Provide consultative services to medical providers and/or department staff regarding healthcare provider quality of care, risk of harm or provider network issues.
• Collaborate with other program ONCs on Independent Medical Examination providers.

Benefits

• Generous retirement package.
• Flexible custom work schedules.
• Teleworking options.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Industry: Administration of Economic Programs
• Education Level: Bachelor's degree