Telephonic Nurse Case Manager

Berkley Medical Management Solutions (a Berkley Company); Schaumburg (IL); On-site; USD 83,000 - 88,000; Full time

Benefits offered by this job

Health insurance

Dental insurance

Vision insurance

Life insurance

Disability insurance

Wellness program

Paid Time Off

401(k) and Profit-Sh Sharing

Job summary

Berkley Medical Management Solutions (BMMS) seeks a Nurse Case Manager to coordinate medical case management and facilitate timely case closure. You will communicate with employers, adjusters, and injured workers, assess treatment utilization, and document progress to drive cost-effective, quality care.

Requires RN license with 2+ years in workers' compensation; CCM preferred. Travel up to 10% domestically; PST business hours; bilingual Spanish/English a plus.

Qualifications

• Graduate of an accredited school of nursing with current RN license.
• 2+ years in workers' compensation and medical case management preferred.
• Bilingual Spanish and English a plus.

Responsibilities

• Coordinate and implement medical case management to facilitate case closure.
• Communicate with employers, adjusters, and injured workers timely and thoroughly.
• Assess medical treatment utilization for cost-effective quality care.
• Review medical records and provide recommendations for case progress to closure.
• Maintain caseloads across varying numbers/territories.
• Obtain and maintain state nursing licensure as required.
• Coordinate home services, DME, IMEs, admissions/discharges, and vocational services.
• Document activities and progress using standard QA practices.
• Attend on-site meetings and participate in special projects as needed.

Skills

Medical case management

Communication skills

Computer skills

Self-motivation

Flexibility

Independent work

Education

RN license

CCM certification preferred

Bachelor of Nursing preferred

RN compact license preferred

Tools

Computer skills

Technology proficiency

Job description

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
• Ability to work Pacific Standard Time business hours
• California RN license greatly 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

The Company is an equal employment opportunity employer.

Important Outside Agency Notice

Only solicited resumes/candidate profiles that are submitted by a Berkley Preferred Agency Partner that have been requested by Berkley Internal Recruiting to engage in a particular search will be subject to the payment of Agency fees as defined in the formal agency agreement. Any unsolicited resumes/candidate profiles are not subject to payment of the agency fees. The company offers a competitive compensation plan and robust benefits package for full time regular employees

• Salary Range: 83k - 88k
• Benefits: Health, Dental, Vision, Life, Disability, Wellness, Paid Time Off, 401(k) and Profit-Sharing plans.

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

Domestic U.S. travel required (up to 10% of time)

Sponsorship Details

Sponsorship not Offered for this Role