Workers Compensation Telephonic Nurse Case Manager (Remote)

Berkley•Jacksonville, FL

19h•$83,000 - $88,000•Remote

About The Position

Berkley Medical Management Solutions (BMMS), part of W.R. Berkley Corporation, provides managed-care services focused on helping injured workers achieve successful and timely returns to work. The company combines clinical practices, return-to-work strategies, technology, data analytics, and professional services to manage workers’ compensation 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, communicates with employers, adjusters, injured workers, and providers, and supports appropriate, cost-effective care and case progression through closure. Domestic U.S. travel of up to 10% is required. The position is remote and requires availability during Pacific Standard Time business hours.

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.
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.
Obtain CCM certification within two years of hire.
Obtain and maintain applicable state certifications and/or licenses in the state where job 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.
Fluency in spoken and written Spanish and English is a plus.

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 through contact with physicians and other specialists to support cost-effective, quality care.
Review and analyze medical records and case data, and recommend actions to progress cases toward 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 home services, durable medical equipment, independent medical examinations (IMEs), admissions, discharges, and vocational services when appropriate; evaluate their 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 working with employers on job analyses to facilitate return to work.
Participate in special projects as assigned by the case management leadership team.
Occasionally attend on-site 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 relation to injured-worker treatment plans and work status.
Obtain and maintain applicable state certifications and/or licenses for the state where duties are performed.
Obtain the case management professional certification (CCM) within two years of hire.
Earn continuing education units to maintain certifications and licensure.