Workers Compensation Telephonic Nurse Case Manager (Remote)

Berkley•Nashville, TN

8d•Remote

About The Position

Berkley Medical Management Solutions (BMMS) provides managed-care services for W.R. Berkley Corporation, combining clinical practices, return-to-work strategies, technology, analytics, and professional services to manage workers’ compensation cases. The Telephonic Nurse Case Manager facilitates timely medical care and return-to-work outcomes for injured workers by assessing, planning, coordinating, monitoring, evaluating, and implementing appropriate services. The role manages assigned cases and caseloads, communicates with employers, adjusters, injured workers, physicians, and other specialists, and documents case activity and progress. The position is remote and requires work during Pacific Standard Time business hours, with domestic travel of up to 10% and occasional onsite meetings or professional programs.

Requirements

Graduate of an accredited school of nursing and hold a current RN license.
At least four years of medical/surgical clinical experience.
Ability to work Pacific Standard Time business hours.
Obtain and maintain applicable state certifications and/or licensures for the jurisdictions where duties are performed.
Obtain CCM certification within two years of hire.
Earn continuing education units to maintain certifications and licensures.
Strong communication skills, professionalism, flexibility, and adaptability.
Working knowledge of medical and vocational resources available to the workers’ compensation industry.
Self-motivation and ability to perform case management duties independently.
Computer and technology skills.
Domestic U.S. travel of up to 10% of work time.

Nice To Haves

At least two years of experience in workers’ compensation insurance and medical case management.
California RN license.
RN compact license.
CCM certification.
Bachelor of Nursing degree.
Oral and written fluency in both Spanish and English.

Responsibilities

Coordinate and implement medical case management to facilitate case closure.
Communicate in a timely and comprehensive manner with employers, adjusters, and injured workers.
Assess utilization of medical treatment and services by contacting physicians and specialists to support cost-effective, quality care.
Review and analyze medical records and assess data, recommending actions to advance case progress and closure.
Manage assigned caseloads, which may vary by number, territory, or state jurisdiction.
Acquire and maintain nursing licensure for jurisdictions as business needs require.
Coordinate and evaluate the cost effectiveness and quality of home services, durable medical equipment, independent medical examinations, admissions, discharges, and vocational services when appropriate.
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 with employers to facilitate disability case management and return to work.
Participate in special projects as 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 applicable state-regulated guidelines, in relation to treatment plans and work status.
Obtain and maintain applicable state certifications and/or licensures where job duties are performed.
Obtain the CCM case management professional certification within two years of hire.
Earn continuing education units to maintain certifications and licensures.

Benefits

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