RN Clinical Liaison

Sheakley is a family owned, outsourced human resources specialty firm dedicated to recognizing and meeting the growing needs of employers. Serving employers since 1963, we've evolved beyond our industry leading workers' comp and unemployment claims management programs to become one of the most respected and trusted providers of comprehensive payroll, time and labor management, and HR solutions and services. We proudly represent more than 50,000 clients.

QUALIFICATIONS

• Maintain a current, active, unrestricted, professional license for RN in the state of Ohio; maintains continuing education as
• Have a minimum of three years of full time direct care experience in a health and human services profession preferably in occupational health or
• Have a minimum of one year of active experience in workers compensation or related health field.
• Maintain continuing education as required to maintain
• Excellent verbal/written communication skills, strong organizational skills and excellent decision making and

REQUIREMENTS

• Attention to detail, flexibility, and ability to multi-task
• Ability to problem solve and communicate effectively with internal and external customers
• Team player with positive attitude
• Ability to adapt to change
• Critical thinking and analysis
• Ability to answer high call volume while maintaining accurate documentation
• Completes tasks timely and thoroughly
• Advanced Microsoft Office and computer skills

PHYSICAL DEMANDS

• Ability to sit for prolonged periods of time

ROLES AND RESPONSIBILITIES

• Reports directly to Director of
• Encompasses previous roles of Medical Dispute Resolution Nurse and Billing Liaison positions.
• Resource for MCO staff (Billing, Medical Dispute, Drug Utilization Review, Utilization Management, Return to Work Specialists, Settlement Coordinator, and others as deemed appropriate), providers, and parties to the claim in data analysis, and in promoting effective communication to facilitate building professional working relationships and resolving disputes.
• Applies and adheres to MCO policy and procedures, and Ohio Bureau of Workers Compensation policies and procedures regarding Medical Dispute, Billing, and Drug Utilization Review, as outlined in the Policy Reference Guide and Billing and Reimbursement Manual.
• Participates in the training, education and evaluation of MCO staff, reviewers and examiners in the Medical Dispute, Billing and Drug Review
• Ability to correctly interpret, analyze and utilize resources such as MCO policy and procedures (Med dispute, Billing, Drug Utilization Review) as outlined in the Policy Reference Guide, Billing and Reimbursement Manual, BWC policy alerts, Miller Criteria, BWC training sessions, Official Disability Guidelines (ODG), and/or treatment guidelines to effectively problem
• Facilitates the optimal processing of data (medical, billing or prescription) via complex claims review to promote patient safety, cost savings and timely return to work (including Legacy claims).
• Collaborates with the MCO's Medical Director regarding Medical Dispute or Drug Utilization Review
• Understands and upholds Sheakley UniComp's philosophy: demonstrates commitment to the Sheakley Core
• Employee may be asked to travel from time to time to attend employer meetings or other offsite
• Other projects as assigned

We offer employees a range of perks including but not limited to:

• Competitive Pay
• Health, dental, vision, and life insurance
• Contributions to your HSA. $1100 for Individual, $2200 for family
• Additional insurance options: Critical Illness, Long Term, Short Term Disability, Accidental Death and Dismemberment, Employee Assistance Program, Legal Shield
• 401(k) savings plan with match after 1 year
• Continuous professional training and development
• 8 Paid Holidays
• Paid Vacation and PTO available
• Employee focused culture with appreciation events all year

Current Openings for RN Clinical Liaison Jobs at DO NOT USE Sheakley Group, Inc DO NOT USE