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The Clinical Services Nurse will work directly with the Clinical Services staff to deliver products developed and/or managed in the Clinical Services department. The services may include, but are not limited to various audits and reports and may also include providing clinical expertise for development of pharmaceutical, ancillary or new business products.

Essential Job Functions

Reviews medical records and prepares written medical case summaries for all report types (i.e.: Level 2 DUR/DUE, Level 3 DUR/Pharmaceutical Drug Review, Intervention RX, Therapeutic Cost Analyses, RxMSA reviews).

Acts as a liaison between customers, PMI sales and marketing staff, claims adjusters, and other internal departments by clarifying requests and obtaining medical information.

Maintains customer information by tracking and compiling billable and non-billable requests and subsequent clinical and non-clinical outcomes.

Prepares and follows up on correspondence, reports and other documents and maintains related medical records.

Maintains relationships with customers by working as a point of contact for Drug Utilization Review medical requests by adjustors.

Coordinates intrathecal program cases as assigned.

Promotes and maintains the Ask-A-PMI Nurse program.

Assist in organizing, distributing, coordinating and streamlining department workflow processes and other business needs as determined by the Clinical Services Manager.

Expected to develop and implement work initiatives to enhance efficiency and improve department clinical and non-clinical outcomes through task direction, assignment, coordination, organization, delegation, and assessment.

Conducts work independently with minimal supervision following departmental policies and procedures.
Required Skills

Excellent verbal and written communication skills.

Able to communicate effectively with healthcare providers and claimants.

Must be able to demonstrate tact, diplomacy and professionalism at all times.

Active listening skills, attention to detail, strong problem-solving skills and the ability to think analytically.

Ability to take initiative and follow through on verbal and written communications.

Ability to work independently and in a team environment.

Ability to manage multiple and changing priorities.  Good time-management and organizational skills.

Knowledge of evidence-based guidelines for disability case management.

Knowledge and proficiency with personal computers and standard Microsoft Applications.

Proficient data entry skills and knowledge of medical terminology and practices.

Must be able to type at least 40 words per minute.

Certifications, Licenses, Registrations

As noted, RN license required and prefer certifications of at least one of the following:  CDMS, CCM, CRRN or COHN.
Required Experience

Bachelor of Science Degree in Nursing, Associates Degree or Diploma Program.

Unrestricted Registered Nurse (RN) license in the state of Ohio.

Must complete all training and/or maintenance for licensure/certification.

Preferred Qualifications

Knowledge and experience with Ohio Workers’ Compensation/PIP laws and regulations. Two years minimum of workers’ compensation case management/managed care experience.

Progressive Medical, Inc. supports a drug and nicotine free work environment. We only hire nicotine free employees. Progressive Medical is an Equal Opportunity Employer. >>>» View or apply to job

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