Medical Review Unit Director - Workers Compensation

Job Description

Job Description

Rising Medical Solutions seeks a Medical Review Unit Director for our Workers Compensation based products and services. This role is ideal for a seasoned professional who is passionate about improving patient care and reducing healthcare costs through effective medical review processes.

The Medical Review Unit Director will oversee the medical review process, ensuring compliance with legal requirements and organizational standards. This position plays a critical role in shaping the strategy for our medical review services and leading a team of qualified healthcare professionals.

Key Responsibilities:

• Direct, manage, and supervise the Medical Review Unit, focusing on Workers Compensation cases.
• Develop, implement, and evaluate clinical review programs and policies to enhance operational efficiency and quality of service.
• Ensure compliance with state and federal regulations, industry standards, and organizational policies.
• Collaborate with internal teams and external partners to promote best practices and improve medical review outcomes.
• Oversee training and development programs for staff to ensure continuous improvement in medical review processes.
• Monitor performance metrics, providing insights and recommendations for optimizing workflows and improving service delivery.
• Facilitate regular team meetings and foster a collaborative environment among nursing and medical professionals.
• Serve as a resource for complex cases, providing necessary clinical expertise and support.
• Engage in stakeholder communication regarding program objectives, outcomes, and revisions.

Requirements

• Registered Nurse (RN) with an active and unencumbered license in the state of operation.
• Bachelor's degree in Nursing; Master's degree preferred.
• 5+ years of clinical experience in the medical field, with a focus on Workers Compensation or related fields.
• 2+ years of leadership experience in a clinical setting; managerial experience is highly preferred.
• Strong understanding of Workers Compensation laws, regulations, and guidelines.
• Exceptional analytical and critical-thinking abilities.
• Excellent interpersonal, written, and verbal communication skills.
• Proficient in the use of electronic medical record (EMR) systems and Microsoft Office Suite.
• Ability to manage multiple priorities and lead a diverse team effectively.
• Strong orientation to customer service and client-focused solutions.
• Commitment to continuous professional development and industry best practices.
• Ability to travel to Corporate office in Chicago for infrequent meetings or training.

Working Conditions:

• Work is typically performed in an office environment with standard office equipment.
• Requires prolonged periods of sitting and working at a computer.

Benefits

• Competitive base salary, profit sharing, comprehensive benefit package including 401k matching, generous time off, and career growth opportunities
• Rising was named a Top Workplace in the healthcare industry for 2023! Check out our profile here: Rising Medical Solutions, Inc Profile (topworkplaces.com)
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