Workers Compensation Telephonic Nurse Case Manager (Remote)

Berkley•Nashville, TN

10d•$83,000 - $88,000•Remote

About The Position

Berkley Medical Management Solutions (BMMS), a managed-care service provider for W.R. Berkley Corporation, combines clinical practices, return-to-work strategies, technology, software platforms, data analytics, and professional services to manage workers’ compensation cases. The company aims to support injured workers’ successful and timely return to work while helping Berkley’s operating units manage cases efficiently and appropriately. The Telephonic Nurse Case Manager assesses, plans, coordinates, monitors, evaluates, and implements options and services to facilitate timely medical care and return-to-work outcomes for injured workers. The role manages assigned caseloads and works with injured workers, employers, adjusters, physicians, and other specialists. The position is remote, requires availability during Pacific Standard Time business hours, and includes domestic U.S. travel of up to 10% of the time. Occasional onsite meetings and professional programs may be required.

Requirements

At least four years of medical/surgical clinical experience.
Graduate of an accredited school of nursing and hold a current RN license.
Ability to work Pacific Standard Time business hours.
Strong communication skills, professionalism, flexibility, and adaptability.
Working knowledge of medical and vocational resources available to the workers’ compensation industry.
Ability to work independently and self-motivation in performing case management duties.
Computer and technology skills.
Obtain the CCM certification within two years of hire.
Obtain and maintain applicable state certifications and/or licensure for the state where duties are performed.
Earn continuing education units to maintain certifications and licensure.

Nice To Haves

At least two years of experience in workers’ compensation insurance and medical case management preferred.
California RN license greatly preferred.
RN compact license preferred.
CCM preferred.
Bachelor of Nursing preferred.
Oral and written fluency in Spanish and English is a plus.

Responsibilities

Coordinate and implement medical case management to facilitate case closure.
Communicate promptly and comprehensively with employers, adjusters, and injured workers.
Assess the appropriateness of medical treatment and available services through contact with physicians and other specialists to support cost-effective, quality care.
Review and analyze medical records and assess data to ensure appropriate case management, recommending actions to advance case progress and closure.
Manage assigned caseloads, which may vary by number, territory, and state jurisdiction.
Acquire and maintain nursing licensure for jurisdictions as business needs require.
Coordinate services such as home services, durable medical equipment, independent medical examinations, admissions, discharges, and vocational services when appropriate; evaluate service cost-effectiveness and quality.
Document activities and case progress using appropriate methods and tools and follow quality-improvement best practices.
Review job analyses and job descriptions with providers and coordinate disability case management, including coordinating job analyses with employers to facilitate return to work.
Participate in special projects assigned by the case management leadership team.
Occasionally attend onsite meetings and professional programs.
Foster a teamwork environment.
Maintain and update evidence-based medical guidelines, including Official Disability Guidelines, MD Guidelines, and required state-regulated guidelines, in reference to the injured worker’s treatment plan and work status.
Obtain and maintain applicable state certifications and/or licenses in the state where job duties are performed.
Obtain the Certified Case Manager (CCM) professional certification within two years of hire.
Earn continuing education units to maintain certifications and licenses.

Benefits

Competitive compensation plan and robust benefits package for full-time regular employees.
Health insurance.
Dental insurance.
Vision insurance.
Life insurance.
Disability benefits.
Wellness benefits.
Paid time off.
401(k) plan.
Profit-sharing plans.