Telephonic Nurse Case Manager

Berkley Medical Management Solutions (a Berkley Company); Harrisburg (Dauphin County); Hybrid; USD 80,000 - 88,000; Full time

Benefits offered by this job

Health insurance

Dental insurance

Vision insurance

Life insurance

Disability insurance

Wellness programs

Paid Time Off

401(k) and Profit-Sharing plans

Job summary

A managed-care service provider is seeking a Telephonic Nurse Case Manager to coordinate timely medical care and facilitate return-to-work outcomes for injured workers. This role requires a minimum of 2 years in workers' compensation insurance and a current RN license. Strong communication skills and adaptability are essential, along with the ability to manage caseloads independently. The position offers a salary range of $80,000 to $88,000, along with comprehensive benefits including health, dental, and 401(k).

Qualifications

• Minimum 2 years of experience in workers’ compensation insurance and medical case management preferred.
• Minimum 4 years of medical/surgical clinical experience required.
• Strong communication skills, professionalism, flexibility, and adaptability.

Responsibilities

• Assess and facilitate timely medical care and return-to-work outcomes of injured workers.
• Coordinate medical case management to facilitate case closure.
• Provide comprehensive communication with stakeholders.

Skills

Communication skills

Flexibility

Adaptability

Self-motivation

Computer skills

Bilingual (Spanish and English)

Education

Graduate of an accredited school of nursing

Current RN license

RN compact license

CCM certification

Bachelor of Nursing

Job description

Telephonic Nurse Case Manager at Berkley Medical Management Solutions (a Berkley Company)

Company Details

Berkley Medical Management Solutions (BMMS) provides a different kind of managed‑care service for W.R. Berkley Corporation. We focus on an injured worker’s successful and speedy return to work, leveraging solid clinical practices, proven return‑to‑work strategies and robust software into one seamless system for workers’ compensation case management.

Responsibilities

• Assess, plan, coordinate, monitor, evaluate, and implement options and services to facilitate timely medical care and return-to-work outcomes of injured workers.
• Coordinate and implement medical case management to facilitate case closure.
• Provide timely and comprehensive communication with employers, adjusters, and the injured workers.
• Assess appropriate utilization of medical treatment and services through contact with physicians and specialists to ensure cost‑effective quality care.
• Review and analyze medical records and assess data to ensure appropriate case‑management processes occur, providing recommendations to achieve case progress and closure.
• Manage assigned caseloads, which may vary by numbers, territory, and/or state jurisdiction.
• Maintain nursing licensure for all jurisdictions as business needs require.
• Coordinate services including home services, durable medical equipment, IMEs, admissions, discharges, and vocational services when appropriate, evaluating cost effectiveness and quality.
• Document activities and case progress using appropriate methods and tools following best practices for quality improvement.
• Review job analysis/job description with all providers to coordinate and implement disability case management, including coordinating job analysis with employers to facilitate return to work.
• Engage and participate in special projects assigned by case‑management leadership team.
• Occasionally attend on‑site meetings and professional programs.
• Foster a teamwork environment.
• Maintain and update evidence‑based medical guideline references (Official Disability Guidelines, MD Guidelines, state‑regulated guidelines) as part of the injured worker treatment plan and work status.
• Obtain and maintain applicable state certifications and/or licensures for the state where duties are performed.
• Obtain case‑management professional certification (CCM) within two years of hire.

Qualifications

• Minimum 2 years of experience in workers’ compensation insurance and medical case management preferred.
• Minimum 4 years of medical/surgical clinical experience required.
• Strong communication skills, professionalism, flexibility, and adaptability.
• Working knowledge of medical and vocational resources available to the workers’ compensation industry.
• Evidence of self‑motivation and ability to perform case management duties independently.
• Evidence of computer and technology skills.
• Oral and written fluency in both Spanish and English is 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.

Salary and Benefits

• Base Salary Range: $80,000 – $88,000.
• Benefits: Health, Dental, Vision, Life, Disability, Wellness, Paid Time Off, 401(k) and Profit‑Sharing plans.

The Company is an equal employment opportunity employer.

We do not accept unsolicited resumes from external recruiting agencies or firms.