Drug Utilization Review RN

POSITION SUMMARY

Performs utilization management of medications prescribed and covered under the Injured Workers' Bureau of Workers' Compensation claim to determine appropriateness and medical necessity as determined by national standard medication guidelines and ensure prescribed medications are related to the BWC claim Allowed conditions. Determines if intervention is needed, collaborates with providers as part of the drug utilization review process, and educates injured workers.

ACCOUNTABILITIES

1. Completes required reviews and interventions in the effort to meet Exceptional Performance quality measures and other initiatives including but not limited to DUR (Drug Utilization Review, Beers/Elderly Injured Worker, High-Risk Drug Utilization.
2. Collaborates with Medical Director when necessary to determine appropriateness of medications and/or identify an alternative safer medication and discuss with prescribing physician to facilitate intervention or change in treatment regimen.
3. Participates in educational and informational seminars as required to maintain credentials, licensures, and qualifications and to meet PMM required education according to our Ohio BWC contract and URAC accreditation. Identifies quality issues and variances and reports to Quality Improvement Staff at Health Management Solutions.
4. Other Duties that may assigned in Nurse Case Management of BWC Claims.

REQUIRED QUALIFICATIONS

Education: Associate in Applied Science or Bachelor of Science in Nursing or graduate of diploma program

Skills: Strong computer, organization, and communication skills; Working knowledge of workers' compensation and case management. Strong collaboration, leadership, and interpersonal skills. Working knowledge of workers' compensation and case management processes and filings. Experience with Utilization Review and/or Drug Utilization. Required to pursue ongoing education and self-development to remain current with industry standards and business objectives related to RN licensure.

Years of Experience: A minimum of 2 years full time equivalent direct acute care clinical experience.

License: Current unrestricted Ohio RN license and, as applicable and based on program need, West Virginia and/or other State RN license that must be maintained throughout employment.

Current Openings for Drug Utilization Review RN Jobs at DO NOT USE Sheakley Group, Inc DO NOT USE