Somc11-2024-00358-Rn Supervisor-Cheyenne

Description and Functions

GENERAL DESCRIPTION:

The RN-Medical Case Supervisor coordinates,develops,and implements policies,procedures, and protocols that guide and support the provision of services by the Nurse Case Managers (NCM) in collaboration with the District Managers and Analysts. The medical case management program monitors, evaluates, and coordinates the delivery of high-quality, timely, cost-effective medical treatment and other health services,as needed by an injured worker with the goal of an appropriateprompt return to work when medically indicated. The NCM facilitates communication between the injured worker, the family representative, community resources, the providers, the analysts, the NCMs, and the District Managers.

Human Resource Contact: Tiffanie Williams - 307-777-2417

ESSENTIAL FUNCTIONS: The listed functions are illustrative only and are not intended to describe every function which may be performed at the job level.

• Plans,directs, manages, coordinates, and evaluates the overall case management process,including preauthorization,peer review,catastrophic response,Durable Medical Equipment (DME),and Chiropracticand Physical Therapyservices.

• Collaborates with the specialty program nurses in the development of policies, procedures, and protocols.

• Provides daily collaboration and feedback to the nurse case managers as necessary to assist with decisions related to claimant care and return to work goals.

• In collaboration with the Workers'Compensation Medical Commission, researches and develops treatment guidelines based on available best practices.

• Responsible for the quarterly meeting agenda, distribution of research and recommendations to the physicianmembers of the panel, the publication of approved treatment guidelines online, and communication of approved treatment guidelines to providers, NCM, analysts, and provider services.

• Participates in the RFP process and acts as an advisor to the Administration in the possible selection of a new PharmacyBenefit Manager.

• Provides input regarding processes to be followed, drug formularies, and best practices surrounding narcoticmonitoring programs.

medical.

• Acts as a lead facilitator in the implementation of any training or education regarding the changing landscape of medical bill reviewandpharmacy and how it relates to Workers' Compensation.

• Investigate and respond to questions and complaints of claimants,providers,legal representatives,NCM,District Managers,and analysts.

• Facilitates multidisciplinary conferences as appropriate.

• Researches and monitors cost containment initiatives and expenditures for services.

• Collects and analyzes clinical statistics and data to determine the appropriateness of services and any necessaryprogram modifications.

• Participates in the ongoing education,training,and development of the NCMs, analysts, and risk managers.

• Acts as the NCM for all DWS claims.

Qualifications

PREFERENCES:

Preference may be given to those with experience as an RN with acquired knowledge of an RN-Medical Case Manager.

Preference may be given toa

Certified Case Manager.

Preference may be given to those with previous leadership experience.

KNOWLEDGE:

• Knowledge of effective problem-solving techniques.

• Effective oral and written communications. counseling and consultative skills; education and training skills.

• Ability to research medical issues.

• Ability to prioritize.

• Ability to demonstrate critical thinking; understanding of and ability to apply medical terminology, physical, and psychosocial principles of nursing.

• Ability to interpret diagnostic testing; decision-making skills while working under tight deadlines.

• Adaptability with the daily schedule; collaboration with other members of the team.

• Knowledge of and development of community resources; previous leadership experience.

MINIMUM QUALIFICATIONS:

Education:

Bachelor's Degree (typically in Nursing)

Experience:

1-3 years of progressive work experience (typically in Nursing) with acquired knowledge at the level of an RN- Medical Case Reviewer

Certificates, Licenses, Registrations:

Must be licensed or eligible for licensure as a Registered Nurse (RN) in the State of Wyoming

OR

Education & ExperienceSubstitution:

4-7 years of progressive work experience (typically in Nursing) with acquired knowledge at the level of an RN- Medical Case Reviewer

Certificates, Licenses, Registrations:

Must be licensed or eligible for licensure as a Registered Nurse (RN) in the State of Wyoming

Necessary Special Requirements

PHYSICAL WORKING CONDITIONS:

• Some travel required as needed.

NOTES:

• FLSA: Exempt

• The Wyoming Department of Workforce Services (DWS) uses E-Verify, an internet-based system, to confirm the eligibility of all newly hired employees to work in the United States. Learn more about E-Verify, including your rights and responsibilities.

Supplemental Information

053-Department of Workforce Services-Workers' Compensation Division

Click here to view the State of Wyoming Classification and Pay Structure.

URL: http://agency.governmentjobs.com/wyoming/default.cfm

The State of Wyoming is an Equal Opportunity Employer and actively supports the ADA and reasonably accommodates qualified applicants with disabilities.

Class Specifications are subject to change, please refer to the A & I HRD Website to ensure that you have the most recent version.