Telephonic Nurse Case Manager - Berkley

Company Details:

 

Berkley Medical Management Solutions (BMMS) provides a different kind of managed-care service for W.R. Berkley Corporation. We believe focusing on an injured worker’s successful and speedy return to work is good for people and good for Berkley’s insurance operating units. BMMS was first started in 2014 by reimagining the relationship between medical need and technology to deliver the best outcome for injured workers and Berkley’s operating units. Our goal was clear: combine solid clinical practices, proven return-to-work strategies and robust software into one system for seamless management of workers’ compensation cases.

 

To get it right, we started with a flexible technology platform that allowed for impressive customization without sacrificing the ability for expansion and continued innovation. We deploy integrated systems to give W.R. Berkley Companies recommendations and professional services for managing each individual case in an efficient and appropriate manner. The power of our technology takes medical bill-review services and clinical advisory services to a new level. Our unique marriage of technology, software platforms, data analytics and professional services ensures we provide Berkley’s operating units with reliable results, and reduced time and expenses associated with case management.

Responsibilities:

 

• Coordinate and implement medical case management to facilitate case closure
• Timely and comprehensive communication with with employers, adjusters and the injured workers.
• Assess appropriate utilization of medical treatment and services available through contact with physicians and other specialist to ensure cost effective quality care
• Review and analyze medical records and assess data to ensure appropriate case management process occurs while providing recommendations to achieve case progress and movement to closure
• Responsible for assigned caseloads, which may vary in numbers, territory and/or by state jurisdiction
• Acquire and maintain nursing licensure for all jurisdictions as business needs require
• Coordinate services to include home services, durable medical equipment, IMEs, admissions, discharges, and vocational services when appropriate and evaluate cost effectiveness and quality of services
• Document activities and case progress using appropriate methods and tools following best practices for quality improvement
• Reviewing job analysis/job description with all providers to coordinate and implement disability case management. This includes coordinating job analysis with employer to facilitate return to work.
• Engage and participate in special projects as assigned by case management leadership team
• Occasionally attend on site meetings and professional programs
• Foster a teamwork environment
• Maintaining and updating evidence based medical guidelines (such as Official Disability Guidelines, MD Guidelines and all required state regulated guidelines) in reference to the injured worker treatment plan and work status.
• Obtain and maintain applicable state certifications and/or licensures in the state where job duties are performed.
• Obtain case management professional certification (CCM) within 2 years of hire date
• Earn Continuing Education Units to maintain certifications and licensures

Qualifications:

• Minimum 2 years of experience in workers compensation insurance and medical case management preferred
• Minimum of 4 years medical/surgical clinical experience required
• Exhibit strong communication skills, professionalism, flexibility and adaptability
• Possess working knowledge of medical and vocational resources available to the Workers’ Compensation industry
• Demonstrate evidence of self-motivation and the ability to perform case management duties independently
• Demonstrate evidence of computer and technology skills
• Oral and written fluency in both Spanish and English a plus

Education 

• Graduate of an accredited school of nursing and possess a current RN license
• RN compact license preferred, CCM preferred, Bachelor of Nursing preferred

Additional Company Details:www.berkleymms.com The Company is an equal employment opportunity employerWe do not accept any unsolicited resumes from external recruiting agencies or firms.The company offers a competitive compensation plan and robust benefits package for full time regular employees.The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment.Additional Requirements:• Low level of domestic U.S. travel required (up to 5% - 10% of time)Sponsorship Details:Sponsorship not Offered for this Role