Berkley

  • Nurse Case Manager

    Location Name MO, Chesterfield - 14755 North Outer Forty
    ID
    2018-1888
    Date Posted
    2 months ago(9/17/2018 8:56 AM)
    Company
    Midwest Employers Casualty
    Primary Location
    US-MO-Chesterfield
    Category
    Managed Care
  • Company Details

    Midwest_Logo

     

     

    Midwest Employers Casualty (MEC) is a Chesterfield, MO based insurance carrier. We improve the quality of life for employees severely injured on the job and help companies understand and mitigate their risk for work comp injuries both catastrophic and non-catastrophic. MEC has a friendly, results-focused work environment. We seek employees who take initiative, are quick to adapt, are dependable, and like working as part of a team.

     

    Our ideal candidate is someone who has a passion for finding solutions to improve injured workers’ quality of life by maximizing medical outcomes, including return to function. An individual with the drive to mitigate loss costs, settle claims by developing relationships, and influence MEC’s customer and claims administrators will thrive at MEC.

     

    Click here to learn more about our culture. 

     

    Company Perks:

    • Tuition/training reimbursement.
    • Flextime with core hours.
    • Bonus structure.
    • 401(k) savings plan with profit sharing.

     

     

    Responsibilities

    What you will do:

    • Claims Exposure
      • Review medical referrals in a timely fashion and provide well-documented concise reviews and detailed action plans.
      • Develop medical cost projections including pre-MSAs.
      • Plan for, request and review Medicare Set Aside evaluations using MEC preferred vendors.
      • Utilize clinical or workers’ compensation background by offering recommendations for treatment.
      • Maintain current clinical knowledge, certifications and licensure through continuing education provided by the company or obtained in independent study or research.

     

    • Relationship management
      • Interact with MEC clients and their representatives according to the MEC brand and the Claims department vision.
      • As part of a regional claims team, the MMC is responsible for support and consultation to Claim Analysts and Attorneys on medical issues including reviews for appropriate diagnosis and treatment, cost containment opportunities, medical cost projections and Medicare Set Aside reviews.
      • Support the work of Claim Analysts and Attorneys to help settle claims.

     

    • Process Improvement
      • Develop solutions to a variety of complex medical management problems and help to implement those solutions.
      • Identify and promote the use of appropriate internal and external resources to improve the medical management of claims.

    Qualifications

    What we require:

    • Minimum 5 years' experience in the field.
    • Certified Case Manager (CCM).
    • RN Certification.
    • Self-Motivated – informed decision-making with the drive to get things done.
    • Collaborative – open to others’ views and supportive of decisions made.
    • Ownership – anticipate, identify solutions, and effectively manage a given process.
    • Influence – effectively communicate direction and demonstrate credibility.

     

     

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