Xerox Nurse First Response (NFR) / Utilization Review Nurse (URN) (Remote / Virtual) in Dallas, Texas

Xerox is the world's leading enterprise for business process and document management. Its services, technology, and expertise enable workplaces - from small businesses to large global enterprises - to simplify the way work gets done so they operate more effectively and focus more on what matters most: their real business. Xerox offers business process outsourcing and IT outsourcing services, including data processing, healthcare solutions, HR benefits management, finance support, transportation solutions, and customer relationship management services for commercial and government organizations worldwide. The company also provides extensive leading-edge document technology, services, software and genuine Xerox supplies for graphic communication and office printing environments of any size. Xerox serves clients in more than 160 countries. For more information, visit www.xerox.com, www.news.xerox.com, www.realbusiness.com or www.xerox.com/businessservices.

If you meet the requirements of this position and want to work for a world-class company with a great marketplace reputation, apply today.

Bunch CareSolutions, A Xerox Company , www.bunchcare.com, is a national medical management company based in Lakeland, Florida. We operate exclusively in the workers’ compensation industry as a full service, managed care firm. Since our founding in 1988, we have consistently grown in size, scope of services and standards of excellence. We have done so without compromising our clinical focus or our mission of “making the world a better place—one life at time.”

Using our clinical expertise, we offer innovative and customized managed care solutions focused on quality outcomes and medical cost containment. Because we are passionate and centered on providing programs built on our core competencies—medical case management and medical bill review—we have been highly successful in shortening claim duration, expediting medical recovery and improving financial and return-to-work outcomes for our clients and their injured employees.

We have an opening for a Nurse First Response (NFR) / Utilization Review Nurse (URN).

Location: Virtual/Remote

Training: 2 weeks onsite training at our Lakeland, FL office.

Work Hours: Mon-Fri;2:00pm-10:30pm EST

Position Overview:

  • This is a project based position which may turn into a full-time position in 3-6 months .

This single position combines the skills of an NFR and URN.

  • NFR - Responsible for providing a telephonic assessment to the injured worker that has not yet received medical treatment. The Registered Nurse will recommend the appropriate route for treatment based on the answers to specific protocols. Plan of care will be determined for self-care or referral for a medical evaluation.

  • URN - Perform prospective, concurrent and retrospective utilization management activities per specified state UR guidelines. This position may be responsible to perform case management activities typically to include medical only claims not in case management services.

Minimum Qualifications NFR:

  • Register Nurse with 3-5 years of clinical experience.

  • Knowledge of ICD9 coding and CPT procedures.

  • Must possess excellent oral communication/telephone skills

  • Must demonstrate the ability to understand state laws and utilization guidelines as they apply to case management activity

  • Ability to work independently and/or in a team setting.

  • Seeks appropriate guidance of supervisory personnel.

  • Strong organization skills and time management.

  • Maintain current nursing license and/or any professional designations that may be required with the jurisdiction.

  • Excellent keyboard and PC automation skills.

Preferred Qualifications – NFR:

  • Clinical experience with Emergency Dept, orthopedic, neurological, rehabilitation, medical/surgical, occupational health or other telephonic triage related services.

Primary Responsibilities – NFR:

  • Collect information to determine appropriate protocol.

  • Provides telephonic assessment for injured workers in a workers compensation environment.

  • Evaluate, assess and implement to determine level of care.

  • Verify injured workers level of understanding about his /her injury and is in agreement with treatment plan.

  • Document the encounter into Bunch’s proprietary software system.

  • Provide the follow up and outcome information to the injured worker, employer and provider when necessary.

  • Supply Injured Worker with self-care instructions and contact information if necessary to call back NFR nurse.

  • Escalate follow-up calls if severity of illness or injury worsens.

  • Documentation is clear, concise and reflects technical and clinical knowledge and effective communication skills.

  • Contributes to overall team performance

Collateral Responsibilities – NFR:

- Flexibility for after hours coverage including nights and weekends.

  • Assist with Triage, Utilization Review and possibly Nurse Case Management.

Performance Expectations – NFR:

  • Under the supervision of a registered nurse, demonstrates the ability to perform basic nursing process (assess, plan, implement, coordinate, monitor and evaluate) in accordance with the established Nurse First Response program.

  • Collect pertinent information from the injured worker and all other relevant sources, needed to develop a collaborative plan to achieve optimal outcomes.

  • Identifies the need to escalate the caller to 911 emergency if injured worker shows signs of clinical decompensation.

  • Demonstrates effective communications and builds collaborative relationships to support the mission and goals of the organization.

  • Demonstrates adherence to Bunch policy and procedures.

  • Appropriately seeks the guidance of a registered nurse as needed to ensure optimal outcomes.

Preferred Qualifications – URN:

  • Clinical nursing experience on an orthopedic/neurology nursing unit.

  • Worker’s compensation or Occupational Medicine or Rehab experience desirable.

  • Utilization review experience desirable.

  • CCM, CDMS, CRRN or CPHM credentials or eligible.

  • Strong organizational and time management skills.

  • Possesses strong mentoring skills.

Primary Responsibilities – URN:

  • Develop and maintain effective professional relationships with injured workers, medical providers, employers and claims adjusters.

  • Demonstrates knowledge and support of the philosophy, purpose and goals of the organization.

  • Demonstrates excellence in communications to ensure customer satisfaction and retention.

  • Anticipates the needs of the claimant and adjusters to produce result-oriented service.

  • Demonstrates basic problem solving skills to ensure early intervention and identification of those injuries which will benefit from medical case management or to identify questionable claims during the utilization review process.

  • Demonstrates basic knowledge of UR process to review all medical treatment requests utilizing state guidelines and proprietary criteria to determine appropriateness and medical necessity.

  • Directs certified care into network providers as applicable.

  • Refers claims back to medical case management unit when work status changes or medical condition warrants per criteria for case management referral policy.

  • Accurately and completely documents in file using standard documentation format(s).

  • Follows all standards, procedures and protocols for URAC accreditation.

  • Applies worker’s compensation regulations,state laws and guidelines to case management activity in assigned territories.

  • Utilizes nationally recognized evidenced based guidelines to make medical necessity decisions.

  • Utilize Physician Advise services to make medical necessity decisions as indicated.

Collateral Responsibilities – URN:

  • Perform within professional practice guidelines set forth by state Board of Nursing and Division of Worker’s Compensation.

  • Demonstrates the ability to work in a team environment and effectively participates in cross-functional teams.

  • Adapts to organizational changes with a professional and positive approach.

  • Demonstrate the ability to manage time effectively and efficiently.

Physical Demands and Word Environment:

The physical demands and work environment characteristics described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

- Physical demands : prolonged sitting; use hands to finger or handle objects or controls; occasionally reach with hands and arms; occasionally lift and/or move up to 15 pounds; frequent talking; hear; prolonged viewing of computer monitor. May include use of stairs or elevator depending on location of work area.

- Work environment : indoor office environment; minimal noise level.

Xerox is an Equal Opportunity Employer and considers applicants for all positions without regard to race, color, creed, religion, ancestry, national origin, age, gender identity, sex, marital status, sexual orientation, physical or mental disability, use of a guide dog or service animal, military/veteran status, citizenship status, basis of genetic information, or any other group protected by law. People with disabilities who need a reasonable accommodation to apply or compete for employment with Xerox may request such accommodation(s) by sending an e-mail to accommodations@xerox.com. Be sure to include your name, the job you are interested in, and the accommodation you are seeking.

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Job: Service Delivery Healthcare

Organization: Workmans Comp Site

Title: Nurse First Response (NFR) / Utilization Review Nurse (URN) (Remote / Virtual)

Location: TX-Dallas

Requisition ID: 16030604

Virtual/work from home? Yes