Behavioral Health Service Authorization Clinical Reviewer

Summary

Your role in our mission

Essential Job Functions

• Provides nursing care for serious occupation and non-occupational injuries and illnesses, based upon nursing assessment, nursing diagnosis and medical directives.
• Investigates quality and quantity of provided health care to determine adherence with company and governmental policies. Provides nursing care for complex occupational illnesses and injuries at various worksites including emergency care and referrals.
• Develops and maintains nursing policy and procedure manuals and ensures that information is communicated to appropriate personnel in an accurate manner. Investigates the potential for improvement, and develops and implements new procedures.
• Serves as case manager for on-site injuries and follow-up care. Assists in determining extent or seriousness of work-related injuries. Administers basic first-aid and assistance and contacts appropriate authorities regarding decisions related to further actions.
• Maintains health related documentation such as employee medical records. Tracks and records exposure to hazardous environments or chemicals and common injuries to ensure prevention of future occurrence. Provides counseling on routine health subjects and referrals to other health care professionals.
• Supervises Guides less experienced staff in the delivery of health care consistent with nursing practice standards and established company policies; ensures that appropriate care is provided in a timely manner.
• Interfaces with line management, safety and industrial hygienists and human resources personnel regarding resolution of pending medical claims or cases related to on-site accidents or injuries to ensure resolution in a timely manner.
• Plans and evaluates health education programs. Establishes, maintains and reviews nursing record keeping systems to ensure confidentiality and adherence to legal requirements.
• Conducts in-service education to ensure standardized application of policy and quality of nursing care. Develops medical directives in collaboration with upper management to ensure safety and hygiene of staff and patients.

Basic Qualifications

• Bachelor's degree or equivalent combination of education and experience
• Bachelor's degree in nursing or related field preferred
• Six or more years of nursing experience
• Experience working with medical procedures and techniques
• Experience working with emergency medical techniques such as cardiac pulmonary resuscitation (CPR) and first aid
• Experience working with company facilities
• Experience working with case management practices
• Experience working with providing health education programs

Other Qualifications

• Communication skills
• Organization and time management skills
• Leadership skills to guide and mentor the work of less experienced personnel
• Interpersonal skills
• Ability to work in a team environment
• Ability to keep sensitive and confidential material private
• Willingness to travel

Work Environment

• Office environment

What we're looking for

What you should expect in this role

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