Workers Compensation - Telephonic Nurse Case Manager (Remote)

Berkley Medical Management Solutions (a Berkley Company); Manassas (VA); On-site; USD 75,000 - 88,000; Full time

Benefits offered by this job

Health benefits

Dental benefits

Vision benefits

Life insurance

Disability insurance

Wellness program

Paid Time Off

401(k) and Profit-Sharing

Job summary

Berkley Medical Management Solutions (BMMS) seeks a Telephonic Nurse Case Manager to assess, plan, coordinate, monitor, evaluate, and implement options to facilitate timely medical care and return-to-work outcomes for injured workers.

The role requires RN licensure with 2+ years in workers’ compensation and medical case management; CCM is preferred. Expect collaboration with employers, adjusters, physicians, and providers across multiple jurisdictions.

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.
• Working knowledge of medical and vocational resources available to the Workers’ Compensation industry.
• Demonstrate self-motivation and ability to perform case management duties independently.
• Demonstrate computer and technology skills; bilingual in Spanish a plus.

Responsibilities

• Coordinate and implement medical case management to facilitate case closure.
• Maintain timely and comprehensive communication with employers, adjusters and injured workers.
• Assess appropriate utilization of medical treatment and services via physicians and specialists.
• Review medical records and data to ensure progress and guide case movement to closure.
• Manage assigned caseloads, varying by state jurisdiction and territory.
• Obtain and maintain RN licensure in required jurisdictions; pursue CCM within 2 years.
• Coordinate services including home care, equipment, IMEs, admissions, discharges, and vocational services.
• Document activities and progress using best-practice tools for quality improvement.
• Review job analyses with providers to coordinate return-to-work plans.
• Engage in special projects and attend on-site meetings as needed.
• Foster a teamwork environment and support colleagues.
• Maintain and update evidence-based medical guidelines (ODG, MD Guidelines) as case plans evolve.
• Sponsoring state certifications/licensures as required.

Skills

Strong communication

Bilingual Spanish/English

Computer skills

Adaptability

Self-motivation

Education

RN license

CCM certification preferred

Bachelor of Nursing preferred

RN compact license preferred

Tools

EHR systems

Job description

Company DetailsBerkley 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.

Company DetailsBerkley 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.

ResponsibilitiesAs a Telephonic Nurse Case Manager, you will 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
• 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

• The above job description is not intended to be an “all-inclusive” list of the duties and responsibilities of the job. Rather, it is intended only to describe the general nature of the job.

The Company is an equal employment opportunity employer.

We 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

• Benefits: Health, Dental, Vision, Life, Disability, Wellness, Paid Time Off, 401(k) and Profit-Sharing plans.
• Base Salary Range: 75k-88k

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