Berkley

Clinical Cost Containment RN-1

Location Name NJ, Hamilton Square
ID
2020-3534
Date Posted
1 month ago(4/15/2020 10:38 AM)
Company
Berkley Accident & Health
Primary Location
US-NJ-Hamilton Square
Category
Managed Care

Company Details

Berkley_Accident_&_Health_Logo

Responsibilities

The Clinical Cost Containment (CCC) RN position affords a seasoned Registered Nurse the ability to use his/her knowledge and experience in a unique and rewarding manner. CCC RNs provide consulting services for internal and external clients and their delegated entities. CCC RNs promote a thorough understanding of current and anticipated clinical needs and expected claims costs while facilitating the use of unique solutions to insure optimal care and claims outcomes. CCC RNs do not interact directly with patients. Our Clinical CCC RNs play in integral role in support of Berkley Accident and Health's vision to be recognized as the industry leader in risk management service. CCC RNs assure optimal clinical outcomes are obtained at a cost commensurate with the level of medical services rendered while also promoting client satisfaction and retention.   Duties and responsibilities include but are not limited to:

  • Develop and maintain relationships with our Clinical team members, other BAH employees and external clients to further BAH's mission.
  • Be responsible for the review of claims, trigger reports, and 50% notice reports to identify catastrophic diagnoses or cases of concern to identify cost savings opportunities.
  • Work in conjunction with Claims department to obtain updated/additional clinical or financial information from the client (TPA, Policyholder, Broker).
  • Collaborate closely with claims team and underwriters, providing ongoing education to better understand the risk and how to manage it.
  • Collaborate with Cost Containment vendors in support of Policyholder optimal outcomes.
  • Understand nuances of each line of business and adjust activities and interventions based on the uniqueness of each market segment.
  • Serve as subject matter reference in our company’s cost containment programs, including but not limited to our interaction with TPAs, Claims, Sales, Underwriters, Client Representatives, and Brokers.
  • Serve as a subject matter reference in analysis of transplant contracts, and provide guidance to the TPA/Case Managers in the selection of the best transplant contract for their client.

Qualifications

  • Requires BA/BS with preference in Nursing or related field  
  • Requires current unrestricted license as a Registered Nurse with 3 - 5 years clinical experience.
  • Certification in Case Management (CCM) preferred
  • Three (3) years of Group medical, managed care, first dollar health insurance, stop loss or reinsurance experience
  • Able to set goals and handle multiple tasks, clients and projects simultaneously; able to appropriately balance priorities, deadlines and deliverables. Able to quickly adapt to change, work under tight deadlines.
  • Proficiency in investigative, analytical, negotiating, persuasion, conflict resolution, critical thinking and problem-solving skill sets
  • Excellent oral, written and interpersonal communication skills.
  • Basic knowledge / comfort working with Microsoft Office and Outlook. Intermediate typing skills
  • Familiarity with Medical Coding
  • Ability to travel 5 - 10 %

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