Workers Compensation Utilization Review Nurse Case Manager (00113024)

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Workers Compensation Utilization Review Nurse Case Manager (00113024)

Salary

$106,581.33 - $135,645.83 Annually

Location

Riverside

Job Type

Regular

Job Number

25-13422-01-DD-WC

Department

Human Resources

Division

Workers Compensation

Opening Date

03/19/2025

Closing Date

4/2/2025 11:59 PM Pacific

ABOUT THE POSITION

HR Logo.png

The County of Riverside’s Department of Human Resources is seeking a temporary and permanent Workers’ Compensation  Utilization Review Nurse Case Manager to support the County of Riverside's  Workers’ Compensation Division.

The most competitive candidates will have knowledge of CA MTUS, ACOEM,ODG and RFA's. Recent nursing experience with Utilization Review for a Workers' Compensation Department or self-insured program is highly preferred.

Additional Pertinent Information:
  • 9/80: In office during training from 8:00am - 5:30pm
  • Opportunity for remote work.

Meet the team!
The Human Resources Department strives to effectively serve and partner with our community, departments and employees by leveraging best practices and innovation to foster a thriving county.

EXAMPLES OF ESSENTIAL DUTIES

• Assesses, plans, implements, coordinates, monitors and evaluates medical services, utilization review and return to work options for injured employees; is a department resource for medical inquiries, claim file reviews, and utilization review.

• Provides medical, behavioral/motivational, occupational, and economic management activities for employees with work related injuries and provides early medical management intervention for new injuries, consulting on medical only and lost time injury files and utilization review on all requests for medical treatment.

• Evaluates health care services of requesting physicians based on the appropriateness of the service and the level of care at which this service would be delivered; is a neutral advocate for employees.

• Performs utilization review in concert with the utilization review physician to approve, delay, modify, or deny treatment.

• Performs medical reviews on Workers' Compensation claims and provides recommendations which are preemptive, focused on moving the injured employee along the healing continuum, return to work opportunities, and employer protection.

• Applies clinical expertise as a resource to the adjuster, employee, and the employer to identify the best results while coordinating the appropriate resource utilization; identifies and manages patient problems to eliminate duplication and fragmentation of health cares service.

• Assists in the development of policies and procedures, standards of care and practice, and in the monitoring of those standards to ensure regulatory compliance, as required by the Division of Workers' Compensation and the Department of Insurance.

• Promotes collaboration among other departments, programs, physicians; represents the Workers Compensation Division when needed in business meetings.

MINIMUM QUALIFICATIONS

OPTION I

Experience: Five years full-time RN experience in a Managed Care or Occupational Health setting to include experience in Workers' Compensation and Utilization Review.

OPTION II

Education: A bachelor's Degree in Nursing, Health Related discipline or Education.

Experience: Three years of experience in Workers' Compensation and Utilization Review.

Possession of a valid California State Public Health Nursing Certificate.

OPTION III

Education: A Master's Degree in Nursing, Health Related discipline or Education.

Experience: Two years of experience in Workers' Compensation and Utilization Review.

Knowledge of: Workers' compensation and utilization review principles and practices; managed care and occupational health issues and standards; application of the nursing process; full range of registered nurse duties and responsibilities; principles and methods of supervision and training; basic management skills; problem solving techniques.

Ability to: Plan, organize, supervise and evaluate nursing services on specific unit(s); communicate effectively; positively manage change and conflict; interpret licensure and accreditation standards; analyze and draft department policies and procedures; apply productive problem solving skills; write clear and concise reports; perform registered nurse or public health nurse responsibilities according to the State of California Nurse Practice Act; implement the nursing process.

SUPPLEMENTAL INFORMATION

For further information regarding this posting, please contact Denise Decamp, (ddecamp@rivco.org)

________________________________________________________________________________________

APPLICATION INFORMATION

Veteran's Preference 
The County has a Veterans Preference Policy applicable to new hires. To qualify, upload a copy of your (or your spouse's) Member-4 Form DD-214 indicating dates of service, and a copy of your spouse's letter of disability (if applicable) with your application. For privacy reasons, it is recommended that you remove your social security information from the document(s). A Human Resources Representative will review the materials and determine if you qualify for veterans' preference. The Veterans Preference Policy, C-3 is available here:  https://rivcocob.org/board-policies 

 

Reasonable Accommodations
The County of Riverside is committed to providing reasonable accommodation to applicants as required by the Americans with Disabilities Act (ADA) and Fair Employment and Housing Act (FEHA). Qualified individuals with disabilities who need a reasonable accommodation during the application or selection process should contact the recruiter for the position noted above. For additional information and/or to obtain the appropriate form for requesting a reasonable accommodation, please visit the Disability Access Office web page located at: https://rc-hr.com/disability 

 

Proof of Education 
If using education to qualify or when requested by the recruiter, upload a copy of any license(s), official/unofficial transcript(s), degrees, and/or related employment documents to your NeoGov account at the time of application and before the closing date. Official or unofficial transcripts will be accepted.

If your education was completed outside of the United States, you will need to provide a copy of your Foreign Education Equivalency evaluation from a member of the National Association of Credential Evaluation Services (NACES) or Association of International Credential Evaluators, Inc. (AICE).

 

Equal Opportunity Employer
The County of Riverside is an Equal Opportunity Employer. It is the policy of the County of Riverside to provide equal employment opportunities for all qualified persons. All applicants will be considered without regard to race, color, religion, sex, national origin, age, disability, sexual orientation, gender, gender identity, gender expression, marital status, ancestry, medical condition (cancer and genetic characteristics), genetic information, or denial of medical and family care leave, or any other non-job-related factors.

 

Pre-Employment
All employment offers are contingent upon successful completion of pre-employment requirements including a criminal background investigation, which involves fingerprinting. (A felony or misdemeanor conviction may disqualify the applicant from County employment).  A pre-employment physical examination and background check may be required.

 

Probationary Period
As an Approved Local Merit System, all County of Riverside employees, except those serving "At Will," are subject to the probationary period provisions as specified in the applicable Memorandum of Understanding, County Resolution, or Salary Ordinance. Temporary and Per Diem employees serve at the pleasure of the agency/department head.

 

General Information
Current County of Riverside and/or current employees of the hiring department may receive priority consideration. Qualified candidates may be considered for future County vacancies. 

 

Job postings may close without notice based on application volume. Submit your complete application by the recruitment close date; no late applications are accepted. Ensure all relevant experience/education is reflected on your application/resume, as a failure to demonstrate position requirements may disqualify applicants. A description of job duties directly copied from the job classification or job posting will not be considered.

 

Please read and follow any special application instructions on this posting. Click the 'Apply' link located on this page to submit your application. For additional instructions on the application process, examinations, Veteran's preference, pre-employment accommodation or other employment questions, please refer to our web site, www.rc-hr.com

 

If you are experiencing technical problems, you may contact the governmentjobs.com applicant support desk Monday through Friday, 6 am to 5 pm Pacific Time at support@governmentjobs.com or toll-free 1-855-524-5627.

Click here to learn more about the benefits of working for the County of Riverside

MEDICAL/DENTAL INSURANCE: A Flexible Benefit Credit is provided on a monthly basis as governed by the Management Resolution or applicable bargaining unit. Vision coverage is provided through Vision Service Plan (VSP) at no cost to employee or eligible dependents.

Note: Employees on assignment through the Temporary Assignment Program (TAP) receive different benefits. See the list here.

MISCELLANEOUS RETIREMENT:  County of Riverside has three retirement Tiers through the California Public Employees' Retirement System (CalPERS).

  • Tier I (Classic Member – Formula 3% @ 60): Applicable to current and former County of Riverside local miscellaneous employees hired prior to 08/24/2012 and did not withdraw CalPERS contributions. The employee contribution is eight (8%) percent.
  • Tier II (Classic Member – Formula 2% @ 60): Applicable to local miscellaneous employees 1) hired after 08/23/2012 through 12/31/2012; 2) Previously employed with another CalPERS contracting public agency or a reciprocal retirement system, with a break in service of less than six months between the separation date with the previous employer and the appointment date with the County of Riverside. The employee contribution is seven (7%) percent.
  • Tier III (PEPRA New Member - Formula 2% @ 62): Applicable to CalPERS local miscellaneous new members hired on or after the implementation of the Public Employees' Pension Reform Act of 2013 (PEPRA) which took effect January 1, 2013. Effective July 1, 2023 employee contributions are 7.25% and will increase to 7.75% effective July 1, 2024.

A new member is defined as any of the following:

  1. A new hire who enters CalPERS membership for the first time on or after January 1, 2013, and who has no prior membership in any California Public Retirement System.
  2. A new hire who enters CalPERS membership for the first time on or after January 1, 2013, and who was a member with another California Public Retirement System prior to that date, but who is not subject to reciprocity upon joining CalPERS.
  3. A member who first established CalPERS membership prior to January 1, 2013, and who is rehired by a different CalPERS agency after a break in service of greater than six (6) months.

CalPERS refers to all members that do not fit within the definition of a new member as "classic members".

Contribution rates are subject to change based on the County of Riverside annual actuarial valuation.

 

Note:

This summary is for general information purposes only. Additional questions regarding retirement formulas can be sent to retirement@rivco.org or by calling the Benefits Information Line at (951) 955-4981,
Option 2.

If you have prior service credit with another CalPERS agency or within agencies, please contact CalPERS at (888) 225-7377 to determine which retirement tier would be applicable to you. CalPERS is governed by the Public Employees' Retirement Law.  The Retirement Law is complex and subject to change.  If there's any conflict between this summary and the law, the law will prevail over this summary.

DEFERRED COMPENSATION: Voluntary employee contribution with a choice between two 457 deferred compensation plan options.

401(a) MONEY PURCHASE PLAN: County contribution of $50 per pay period towards choice between two 401(a) plan providers.

ANNUAL LEAVE (Bi-Weekly Accrual):
0 < 36 months = 8.92 Hours
36 to <108 months = 10.46 Hours
108 or more months = 12.00 Hours

Maximum Annual Leave accumulation is 1,800 hours. Employee may receive pay in lieu of up to 80 hours per calendar year. Agency/Department Head may approve an additional 80 hours.

HOLIDAYS: Normally 12 paid holidays per year.

BEREAVEMENT LEAVE: 5 days (3 days are County paid; 2 days can be taken through use of accrued leave balances).

BASIC LIFE INSURANCE: $50,000 of term life coverage. Premiums are paid by the County. Additional Supplemental Life plan is available for employee purchase.

LONG-TERM DISABILITY (LTD): Benefit pays 66.67% of earnings to a maximum of $10,000 per month; 30-day waiting period; pays to age 65. Benefit can be coordinated with other available leave balances to provide up to 100% of pay.

POST RETIREMENT MEDICAL CONTRIBUTION: A monthly contribution is made by the County towards retiree health insurance offered through the County as governed by the Management Resolution or applicable bargaining unit.

OTHER: There may be other benefit provisions as specified in the applicable Memorandum of Understanding, Management Resolution, or Salary Ordinance. Please contact the recruiter listed on the job posting directly for more information.

01
Do you possess a current, valid license to practice as a Registered Nurse in the state of California?
  • Yes
  • No
02
Please provide your Registered Nurse Licensure Number.
03
What is your highest level of education from an accredited college or university in Nursing, Health Related discipline or Education?
  • None
  • I have my Associates degree
  • I have my Bachelors degree
  • I have my Masters degree
  • I have my Doctorate degree
04
Do you have a valid, current license to practice as a Public Health Nurse in the State of California?
  • Yes
  • No
05
How many years of experience do you have working in Workers' Compensation and Utilization Review?
  • None
  • Less than 1 year
  • 1 year or more, but less than 2
  • 2 years or more, but less than 3
  • 3 years or more, but less than 4
  • 4 years or more, but less than 5
  • 5 years or more, but less than 6
  • 6 years or more
06
How many years of full-time experience do you have as a Registered Nurse in a Managed Care or Occupational Health setting to include experience in Worker' Compensation and Utilization Review?
  • Less than 1 year
  • 1 year, but less than 2
  • 2 years, but less than 3
  • 3 years, but less than 4
  • 4 years, but less than 5
  • 5 years, but less than 6
  • 6 years or more
07
Do you have experience working with RFA's? (Please ensure that your resume reflects this experience.)
  • Yes
  • No
08
Do you have knowledge of CA MTUS, ACOEM, and ODG? (Please ensure that your resume reflects this experience.)
  • Yes
  • No
09
Are you a current regular, part time, temporary, per diem, or seasonal employee with the County of Riverside?
  • Yes
  • No
10
Are you interested in a temporary Workers' Compensation Utilization Review Nurse Case Manager?
  • Yes
  • No

Required Question

Employer
County of Riverside
Address
County Admin. Center P.O. Box 1569
4080 Lemon St., 7th floor
Riverside, California, 92502-1569
Phone
(951) 955-3500