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.
What You'll Do:
- Performs case management, billing, and clinical related audits for the Managed Care Organizations.
- Monitors and conducts performance guarantees review for the Pharmacy program.
- Conducts monitoring reviews for various areas.
- Assists in identifying risk areas in medical management process.
- Develops compliance and audit programs.
Required Experience and/or Education:
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 and 6 months experience as licensed Registered Nurse.
Required Experience and/or Education:
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 and 6 months experience as licensed Registered Nurse.
MAJOR WORKER CHARACTERISTICS:
Knowledge of nursing; medical case management*; HIPAA regulations; federal & state laws & department rules
governing workers' compensation & medical claims ; interviewing ; human relations. Skill in use of medical equipment
(e.g., stethoscope, sphygmomanometer) & personal computer *. Ability to interpret diagnosis, assess limitations & write
accurate medical reports based on claimant data; read & comprehend medical charts, manuals & journals; handle
inquiries from & contacts with managed care organizations, physicians, legal representatives, government officials &
general public; handle sensitive contacts with injured workers who may be hostile, depressed or suicidal.
(*)Developed after employment.
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