Mitchell International, Inc.

  • Senior Nurse Reviewer, Utilization 1

    Job Location US-CA-Sacramento
    Job ID
    18-8309
    Type
    Regular Hire
  • Company Overview

    Mitchell International, Inc. is a leading provider of information and workflow solutions to the Property & Casualty Claims Industry and their supply chain partners. We solve interesting and complex problems that directly affect the customers our clients serve. We are constantly adapting to stay on the forefront of emerging technologies and we work diligently to maintain our position as a thought leader within our industry.

     

    Mitchells workers compensation national managed care program offers solutions for insurance carriers, third-party administrators and employers. We recommend an integrated suite of solutions that include utilization review and case management with a focus on managing total claims costs while expediting safe return to work.

     

     

    Job Description

    Quality Integration-Case Management

     

    Facilitates objective and systematic measurement, monitoring and evaluation of the quality of Mitchell International Managed Care services through quality management audits and education. Uses audit outcomes to plan and conduct efficient processes via QIPs, staff training and analyses of existing processes. Works as liaison with software developers to improve efficiencies and throughput, while maintaining quality standards. Facilitates standardization and optimization of processes across Mitchell's managed care processes.

     

    • Identify and develop targeted training necessary to address Quality Assurance (QA) issues.
    • Conduct UR Quality Audits on clinical and/or non-clinical functions and report results to management.
    • Daily processing and distribution of QA tickets from QA log.
    • Develop and update training documents, best practices and process documents to address operational needs.
    • Identify and facilitate Quality Improvement Projects per URAC and state requirements
    • Special projects as assigned by supervisor and management.
    • Analyzes clinical information to identify care needs and strategize with all parties to create common goals in order to reach maximum quality. Based on this analysis, develops pro-active action plans to outline expected barriers and recommend solutions.
    • Understands and complies with current industry accepted case management guidelines.
    • Stays informed and complies with state/federal legislation as it applies to case management for an assigned geographic region.
    • Provides leadership and assistance to co-workers.
    • Stays informed of healthcare industry current practices and trends.

     

    Knowledge: A clinical background related to trauma, neurological, orthopedic, or occupational health nursing is required. Worker’s compensation experience is required.

     

    Job Complexity: Works on problems of diverse scope where analysis of data requires evaluation of identifiable factors. Demonstrates good judgment in selecting methods and techniques for obtaining solutions. Networks with senior internal and external personnel in own area of expertise.

     

    Supervision: Director of Quality Integration

    Qualifications

    • Three or more years’ experience in disability management and/or utilization management is required.
    • Current, valid professional health clinical license required for clinical auditing, with certification in utilization management and/or case management preferred.
    • Previous Quality Assurance experience preferred, but not required.
    • Well developed communication and interpersonal skills. Works well within a team setting to achieve the provision of the highest quality of results oriented service.
    • Proficiency in Microsoft Office suite required.
    • Strong verbal and written presentation skills.
    • Proficient use of databases and data analysis to develop customer oriented operational excellence.
    • Multi-state knowledge/experience is preferred.
    • Licenses or Certifications: All applicants must be a Licensed Nurse. CCM, COHN preferred or able to sit for exam within one year of employment.
    • Location: Remote, home office.

    *Requires DSL, fiber or cable internet connection from home. 1 mbps preferred or better.*

     

    Physical Requirements: Candidate must be able to sit the majority of an 8 hour day with the exception of lunch and break times. Candidate must be able to keyboard the majority of an 8 hour day with the exception of lunch and break times. Candidate must have manual dexterity. Candidate must be able to speak on the telephone intermittently throughout the day. Candidate must be able to read and write English fluently. Candidate must be able to provide and confirm safe home office environment. Home office must be HIPPA compliant.

     

     

     

    Mitchell International, an equal opportunity employer, values the diversity of our workforce and the knowledge of our people.  Mitchell will not discriminate against an applicant or employee on the basis of race, color, religion, national origin, ancestry, sex/gender, age, physical or mental disability, military or veteran status, genetic information, sexual orientation, gender identity, gender expression, marital status, or any other characteristic protected by applicable federal, state or local law.

     

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