Part-Time: Workers Compensation Telephonic Nurse Case Manager (Remote)

Berkley•Manassas, VA

1d•Remote

About The Position

Berkley Medical Management Solutions (BMMS) provides managed-care services for W.R. Berkley Corporation, focusing on the successful and speedy return to work for injured workers. Established in 2014, BMMS integrates solid clinical practices, proven return-to-work strategies, and robust software to seamlessly manage workers’ compensation cases. The company utilizes a flexible technology platform for customization and innovation, deploying integrated systems to offer recommendations and professional services for efficient and appropriate case management. Their unique combination of technology, software platforms, data analytics, and professional services aims to deliver reliable results and reduce time and expenses associated with case management for Berkley’s operating units. This part-time position involves assessing, planning, coordinating, monitoring, evaluating, and implementing options and services to facilitate timely medical care and return-to-work outcomes for injured workers.

Requirements

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
Graduate of an accredited school of nursing and possess a current RN license

Nice To Haves

Minimum 2 years of experience in workers compensation insurance and medical case management preferred
Oral and written fluency in both Spanish and English a plus
RN compact license preferred
CCM preferred
Bachelor of Nursing preferred

Responsibilities

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 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