Industrial Rehabilitation Nurse - PN: 20068801

About the role

BWC’s core hours of operation are Monday-Friday from 8:00am to 5:00pm, however, daily start/end times may vary based on operational need across BWC departments. Most positions perform work on-site at one of BWC’s seven offices across the state. BWC offers flex-time work schedules that allow an employee to start the day as early as 7:00am or as late as 8:30am. Flex-time schedules are based on operational need and require supervisor approval. The report in location for these positions will be determined based on who is ultimately recommended.

Responsibilities

• Completes 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 & analyzes subjective & objective evidence for medical indicators to determine if they were caused and/or have not been caused by the workplace injury/illness; identifies & reports claims situations where further clarification &/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, employers, 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.

Job Skills

• Nursing
• Federal & state laws
• BWC policies & procedures*
• Case management strategies
• ICD & ICDM codes
• Interviewing
• Public relations
• Medical techniques, procedures, & definitions
• 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
• Organize

What You’ll Be Doing

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 & analyzes subjective & objective evidence for medical indicators to determine if they were caused and/or have not been caused by the workplace injury/illness; identifies & reports claims situations where further clarification &/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, employers, and/or providers for optimal claim outcome for recovery and return to work (if feasible).

Qualifications

• 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.

Skills

• Analyze
• Ethics and Values
• Reasoning
• Strategic Thinking
• Written Communication

Benefits

BWC conducts an internal engagement survey on an annual basis. Some comments from our employees include:

• BWC has been a great place to work as it has provided opportunities for growth that were lacking in my previous place of work.
• I have worked at several state agencies and BWC is the best place to work.
• Best place to work in the state and with a sense of family and support.
• I love the work culture, helpfulness, and acceptance I've been embraced with at BWC.
• Continuously impressed with the career longevity of our employees, their level of dedication to service, pride in their work, and vast experience. It really speaks to our mission and why people join BWC and then retire from BWC.

What You’ll Be Doing

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 & analyzes subjective & objective evidence for medical indicators to determine if they were caused and/or have not been caused by the workplace injury/illness; identifies & reports claims situations where further clarification &/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, employers, and/or providers for optimal claim outcome for recovery and return to work (if feasible).

Qualifications

• 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.

Skills

• Analyze
• Ethics and Values
• Reasoning
• Strategic Thinking
• Written Communication

Agency Overview

A Little About Us: With roughly 1,500 employees in seven offices across Ohio, BWC is the state agency that cares for Ohio workers by promoting a culture of safety at work and at home and ensuring quality medical and pharmacy care is provided to injured workers. For Ohio employers, we provide insurance policies to cover workplace injuries and safety and wellness services to prevent injuries.

Our Culture: BWC is a dynamic organization that offers career opportunities across many different disciplines. BWC strives to maintain an inclusive workplace. We begin by being an equal opportunity employer. Employees can participate in and lead employee work groups, participate in on-line forums and learn about how different perspectives can improve leadership skills.

Our Vision: To transform BWC into an agile organization driven by customer success.

Our Mission: To deliver consistently excellent experiences for each BWC customer every day.

Our Core Values: One Agency, Personal Connection, Innovative Leadership, Relentless Excellence.