National Catastrophic Medical Consultant

Berkley•Town and Country, MO

13d

About The Position

The National Catastrophic Medical Consultant ( NCMC) is a dynamic nurse (RN) who provides expert medical management and cost containment advice and oversight to our clients' catastrophically injured workers. In collaboration with MEC's Medical Director, Claim Analysts and Attorneys, external claim administrators (TPAs and others), field nurse case managers and clients, the Senior NCMC will assist in maximizing injured worker's medical outcomes, including return to function, while minimizing the financial risk to MECC and its clients.

Requirements

Bachelor's or Master's degree in nursing.
Current and active RN license in the State of Residency.
Advanced certification, such as Medicare set aside consultation certification (MSCC), certified case manager (CCM), or certified life care planner (CLCP).
Minimum 5 years' experience as workers' compensation as a catastrophic nurse case manager.
Experience in catastrophic case management is essential.
Has a complete understanding of principles, concepts and practices relating to excess workers' compensation insurance claims.
Proven experience in the management of complex catastrophic medical claims in an excess workers' compensation setting.
Knowledge of available external resources, including centers of excellence, field nurse case managers and other vendors that assist in the management of catastrophically injured workers.
Demonstrates critical thinking and analysis skills.
Demonstrates excellent written and oral communication and negotiation skills.
Excellent listening and interpersonal skills.
Keen attention to detail.
Highly self-motivated and directed.
Demonstrates proficiency in the use of Microsoft Office products.

Nice To Haves

Experience in disability management, utilization review or pharmaceutical management is highly desirable.

Responsibilities

Provides support and consultation to Claim Analysts and Attorneys on medical issues including reviews for appropriate diagnosis and treatment and cost containment opportunities.
Serves as an expert consultant and subject matter expert to MEC (including other MMCs) and its clients on claim medical management and medical cost containment.
Develops solutions to a variety of complex medical management problems and helps to implement these.
Identifies and promotes the use of appropriate internal and external resources to improve the medical management of catastrophic claims.
Helps to assess the effectiveness of external resources in managing the medical aspects of claims.
Educates internal and external parties on catastrophic case management and best use of centers of excellence and other vendors.
Is available for consultation with internal staff and external parties (clients, brokers, TPAs and field case managers) on best practices.
Oversees the medical management of catastrophically injured claimants, utilizing preferred vendors strategically and ensuring that appropriate care is being delivered.
Supports the work of Claim Analysts and Attorneys to help settle claims.
Reviews medical referrals in a timely fashion and provides well-documented concise reviews and detailed action plans.
Interacts with MEC clients and their representatives according to the MECC brand and the Claims department vision.
Operates independently, executing plans under minimal supervision.
Presentations on a regular basis in conferences or webinars, podcast.
Other duties as assigned.
Responsible for maintaining current clinical knowledge, certifications and licensure through continuing education provided by the company or obtained in independent study or research.