REGISTERED NURSING CONSULTANT - 43001996

Provide monitoring and oversight of the Pharmacy Benefit Manager contractor by conducting audits on prescription payments, reviewing reports, completing a monthly monitoring checklist, audit and refund tracking, maintaining an organized and complete contract folder, reviewing invoices, and communicating with the contractor on a routine basis. Provide monitoring and oversight of medical bill review, re-pricing, and pre-certification programs by conducting audits on selected medical bills being processed by the Medical Bill Review contractor. Provide monitoring and oversight of medical case management activities by conducting audits on selected claims in the Medical Case Management contractor’s system. Provide nursing consultation and medical expertise to Division staff on workers' compensation claims concerning, but not limited to: evaluating medical care and supplies furnished by providers, appropriateness of the level of service provided, treatment rendered in relationship to the injury, codes billed versus the treatment actually rendered, and monitoring rehabilitation services. Perform related work as required.