Workers Compensation - Telephonic Nurse Case Manager (Remote)

Berkley•Manassas, VA

6d•$75,000 - $88,000•Remote

About The Position

Berkley Medical Management Solutions (BMMS) provides a managed-care service for W.R. Berkley Corporation, focusing on injured workers' successful and speedy return to work. BMMS was established in 2014 by integrating medical need and technology to deliver optimal outcomes for injured workers and Berkley’s operating units. The goal was to combine solid clinical practices, proven return-to-work strategies, and robust software into a seamless system for managing workers' compensation cases. BMMS utilizes a flexible technology platform for customization and expansion, deploying integrated systems to provide W.R. Berkley Companies with recommendations and professional services for efficient and appropriate case management. The combination of technology, software platforms, data analytics, and professional services ensures reliable results and reduced time and expenses associated with case management.

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.
Communicate in a timely and comprehensive manner with employers, adjusters, and injured workers.
Assess appropriate utilization of medical treatment and services by contacting physicians and other specialists to ensure cost-effective quality care.
Review and analyze medical records and assess data to ensure appropriate case management processes occur, providing recommendations for case progress and closure.
Manage assigned caseloads, which may vary in numbers, territory, and/or state jurisdiction.
Acquire and maintain nursing licensure for all jurisdictions as business needs require.
Coordinate services including home services, durable medical equipment, IMEs, admissions, discharges, and vocational services when appropriate, evaluating cost-effectiveness and quality.
Document activities and case progress using appropriate methods and tools, following best practices for quality improvement.
Review job analysis/job description with all providers to coordinate and implement disability case management, including coordinating job analysis with the employer to facilitate return to work.
Engage and 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 (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 licenses 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 licenses.