Berkley

  • Telephonic Nurse Case Manager

    Location Name KS, Overland Park
    ID
    2018-2111
    Date Posted
    5 days ago(12/4/2018 3:08 PM)
    Company
    Berkley Med Mgt Solutions
    Primary Location
    US-KS-Overland Park
    Category
    Managed Care
  • Company Details

    Berkley Medical Management Solutions provides a different kind of managed-care service for W. R. Berkley Insurance Group. Too often, vended managed-care services focus on billable services instead of getting injured or ill employees back to work quickly with the best possible outcomes. We started by reimagining the relationship between medical need and technology as a way to deliver the best outcomes. The goal was clear: combine solid clinical practices, proven return-to-work strategies and robust software into one system for seamless management of workers’ compensation cases.

     

    The power of our technology takes medical bill-review services, clinical advisory solutions, and data analytics to a new level. We deploy integrated systems and, where appropriate, outsourced services to give W. R. Berkley Insurance Group recommendations and professional services for managing cases in an efficient and appropriate manner for each jurisdiction.  Our services help the clients of W. R. Berkley Insurance Group better manage their workers' compensation cases and return their employees to work faster with better outcomes.

     

    Associates of Berkley Medical Management Solutions demonstrate our commitment to harnessing the power of data to improve injury outcomes. Through an ongoing commitment to innovation, continuous improvement and education, we attract and retain associates with a unique blend of expertise and a passion for excellence.

    Responsibilities

    • Job Purpose

    Assess, plan, coordinate, monitor, evaluate and implement options and services to facilitate timely medical care and return to work outcomes of injured workers.

    • Major Accountabilities
    1. Coordinate and implement medical case management to facilitate case closure.
    2. Assess appropriate utilization of medical treatment and services available through contact with physicians and other specialist to ensure cost effective quality care.
    3. 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.
    4.      Responsible for assigned caseloads, which may vary in numbers, territory and/or by state jurisdiction.
    5.      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.
    1. Document activities and case progress using appropriate methods and tools following best practices for quality improvement.
    2. Coordinate job analysis with employer to facilitate return to work.
    3. Perform other duties and special projects as assigned by case management manager.
    4. Occasionally attend on site meetings and professional programs.
    5. Review job analysis with physician.
    • Key Performance Indicators
    1.      Documentation of cost savings.
    2.      Meeting or exceeding productivity standards
    3.      Meeting or exceeding quality improvement standards
    1. Possess a teamwork orientation.

    Qualifications

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

    Applicable state certifications in the state where job duties are performed.

    Master’s Degree in Vocational Rehabilitation or associated post-graduate degree for Vocational Case Managers.

    Obtain other professional certifications as appropriate (CCM, CRRN, CDMS, COHN, CRC).

    Earn Continuing Education Units to maintain certifications.

    Designated professional certification must be obtained within 2 years of hire date.

     

    Minimum of two (2) year experience in insurance rehabilitation and medical/vocational rehabilitation preferred.

    Possess working knowledge of medical and vocational resources available to the Workers’ Compensation industry.

    Possess knowledge of principle insurance, Worker’s Compensation laws, disability systems, and/or the Dictionary of Occupational Titles (DOT)

    Exhibit well-defined leadership and interpersonal skills

    Demonstrate evidence of self-motivation and the ability to perform case management duties independently.

    Comfortable working with a computer and other technology resources to aid in completion of assigned job accountabilities.

    Oral and written fluency in English. Spanish is a plus

     

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