[Hiring] Workers Compensation Telephonic Nurse Case Manager @Berkley

Role Description

As a Telephonic Nurse Case Manager, you will 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 specialists 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.
• Review job analysis/job description with all providers to coordinate and implement disability case management, including 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.
• 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 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.

Qualifications

• Minimum 2 years of experience in workers compensation insurance and medical case management preferred.
• 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.
• Oral and written fluency in both Spanish and English a plus.

Requirements

• Graduate of an accredited school of nursing and possess a current RN license.
• RN compact license preferred, CCM preferred, Bachelor of Nursing preferred.

Benefits

• Competitive compensation plan.
• Base Salary Range: $75,000 - $88,000.
• Health, Dental, Vision, Life, Disability, Wellness, Paid Time Off, 401(k), and Profit-Sharing plans.