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Company Berkley Medical Management Solutions
Location Name CA, San Diego - 9797 Aero Drive
The Nurse Case Management Supervisor provides coaching, leadership and acts as a resource to a team of Nurse Case Managers and unlicensed clinical professionals. You are responsible for timely case assignments, quality reviews, and supporting staff members to maximize caseloads with high clinical value. You’ll also be responsible for assisting in budget preparation and adhering to budget parameters. This is a working leadership role and the supervisor will manage a modified caseload. #LI hybrid   Key functions include but are not limited to the following:   - Lead by example to support a highly functioning synergistic managed care team - Provides Service Recovery using the BMMS Cultural Values and per BMMS Policy and Procedures as a foundation - Assists in the development of nursing competencies, manages competencies to ensure proficiency, and assesses each team member annually - Assume case management responsibilities to assist staff in maintaining timely case management services and to provide vacation coverage - Interview and facilitate hiring of new nurse case managers and BMMS team members - Orient all new hires - Oversees and ensures proper timekeeping and payroll timecard entries - Prepare performance evaluations; provide counseling and goal setting - Establish and maintain positive working relationships with co-workers, team members, leadership, vendors and the Berkley operating units to further BMMS’ mission and reputation in the managed care community - Timely reports any trends, changes, or suggested enhancements to senior leadership - Maintains a professional presence, at all times, and the ability to communicate effectively with all levels of staff and clients - Culturally competent with a focus on creating a culture of psychological safety - Completes assigned tasks and projects timely, efficiently, and with accuracy - Must be flexible and adaptable to an evolving work environment - Other duties as assigned
ID
2022-7714
Primary Location
US-CA-San Diego
Company Berkley Medical Management Solutions
Location Name MA, Boston - 99 Summer Street - Suite 1000
The Paralegal role will assist and provide a range of legal support and administration to leadership as well as the Berkley operating unit stakeholders. This role will stay abreast of workers compensation and pharmacy regulatory changes.   Key functions include but are not limited to the following: - Conduct legal research, including factual research - Conduct record searches - Identify relevant statues, legal articles, codes and other pertinent material - Organize and analyze information - Prepare regulatory updates and newsletters - Prepare legal correspondence - Build and maintain databases and files, and systems to collect, store, and retrieve data - Review, monitor and communicate new and updated laws and regulations - Draft legal documents including agreements, contracts and legal memoranda - Review, edit, and redline contracts, agreements and amendments to contracts as needed - Maintenance of nurse medical licenses, state licenses and other necessary requirements to support the daily business needs of the company - Work directly with W.R. Berkley corporate entity regarding regulatory, security and other assigned initiatives - Collaborate with both internal corporate counsel and outside counsel as needed - Responsibility for coordination, monitoring, and documenting Rules Committee meetings
ID
2022-7601
Primary Location
US-MA-Boston
Company Berkley Medical Management Solutions
Location Name MA, Boston - 99 Summer Street - Suite 1000
The Director of Case Management is responsible for achieving operational excellence in the areas of nurse case management.  This includes co-creating with the AVP, Operations and BMMS leadership team a vision for success, performance measurements, managing BMMS team toward these goals, and identifying opportunities for and driving to optimal injury rehabilitation outcomes, increased savings, reduced cost, and enhanced customer service.  These efforts will support the organization’s strategic mission to improve and expand business and financial results.   The Director, Case Management provides leadership and executive guidance in the areas of nurse case management. - Direct all aspects of the nursing department - Oversight of operations and business integration between BMMS nurses and clients (Berkley Operating Units) including SME contribution to the development of business requirements that drive technical solutions; - Direct the nurse case management team to identify, generate and collect vital measurements and plans to maximize customer satisfaction, quality, and productivity/efficiency - Drive process changes across the nursing department to improve Key Performance Indicators - Oversee nurse case management projects as lead business/operational business SME - Decision-making responsibility consistent with directing daily nurse case management operations consistent with leadership vision - Lead the interview, hire and orientation processes for new members of the nurse case management team - Collaborate with senior leadership team in developing vision & mission for nurse case management - Work with product development team to create new tangents of the nursing team - Serves as the primary point of contact for escalated nurse case management service issues - Manages staff responsible for monitoring and resolving daily nurse case management service issues - Ensures a heightened level of customer satisfaction by overseeing and directing staff management and resolution of client service issues - Develop and implement best practices across BMMS to provide visibility to nurse case management and analyze sustainable improvements to performance - Build and sustain effective communications with all stakeholders, partner vendors, clients/Berkley Operating Units, BMMS leadership, and cross-functional analytical and IT teams to maximize the customer experience and drive efficiencies - Mentor & coach staff as a hands-on leader to develop and retain key talent and ensure the quality selection of candidates to build out teams with top talent - Establish and manage staff to performance goals and objectives
ID
2022-7578
Primary Location
US-MA-Boston
Company Berkley Medical Management Solutions
Location Name CA, San Diego - 9797 Aero Drive
The Telephonic Nurse Case Manager will assess, plan, coordinate, monitor, evaluate and implement options and services to facilitate timely medical care and return to work outcomes of injured workers. #LI hybrid   Key functions include but are not limited to the following: - Coordinate and implement medical case management to facilitate case closure - Assess appropriate utilization of medical treatment and services available through contact with physicians and other specialist 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 - 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 - Coordinate job analysis with employer to facilitate return to work - Perform other duties and special projects as assigned by case management manager - Occasionally attend on site meetings and professional programs - Review job analysis with physician - Exhibit strong communication skills, flexibility and adaptability - Foster a teamwork environment - Documentation of cost savings - Meeting or exceeding productivity standards - Meeting or exceeding quality improvement standards
ID
2022-7468
Primary Location
US-CA-San Diego
Loc2
California
Company Berkley Medical Management Solutions
Location Name CA, San Diego - 9797 Aero Drive
The Clinical Care Specialist I (CCS) works collaboratively with nurses and other professional staff members to support the daily functions of the managed care department and they will access multiple systems to obtain necessary documentation for processing.  #LI hybrid   Key functions include but are not limited to the following: - Effectively communicate with nursing staff, adjusters, medical providers, injured workers, and any other parties involved in a case to obtain and confirm information, and ensure case needs are clearly understood - Complete timely requests for medical notes and other case information from medical providers, including effective follow through to secure the documentation in a timely fashion - Completion of case tasks within the expected timeframe - Collaborates regularly with nursing staff and adjusters to provide status updates on task completion - Administers referrals for operating units and Nurse Case Managers - Sets tasks for Nurse Case Managers and self in each assigned case and monitors tasks daily for timely completion - Bills for all time spent within the appropriate cases - Updates injured worker demographic and/or attorney information, work status and/or network provider information when needed or as requested - Initiate, retrieve, coordinate and forward medical records to vendors, medical providers, adjusters, and Nurse Case Manager staff as requested - Requests verbally and/or in writing, medical notes, work status reports, and next office visit information with follow up communications to appropriate parties as information is obtained or when barriers occur to provide status updates - Confirm medical appointments, therapy visits, translation/transportation visits as requested by the Nurse Case Manager - Create and send out letter(s) to the injured worker and appropriate parties, as clarified by the Nurse Case Manager based upon state jurisdiction and legal representation demands - Document essential functions completed within the assigned file per established policies and procedures - Practice strict confidentiality in the handling of all data and communications in the performance of daily tasks - Coordinate and successfully complete specific projects and initiatives as directed - Solicits and incorporates suggestions from other team members to improve and streamline workflow - Attend training sessions and meetings in-person and virtually as needed
ID
2022-7174
Primary Location
US-CA-San Diego
Loc2
California
Company Berkley Medical Management Solutions
Location Name MA, Boston - 99 Summer Street - Suite 1000
The Clinical Care Specialist I (CCS) works collaboratively with nurses and other professional staff members to support the daily functions of the managed care department and they will access multiple systems to obtain necessary documentation for processing.   Key functions include but are not limited to the following: - Effectively communicate with nursing staff, adjusters, medical providers, injured workers, and any other parties involved in a case to obtain and confirm information, and ensure case needs are clearly understood - Complete timely requests for medical notes and other case information from medical providers, including effective follow through to secure the documentation in a timely fashion - Completion of case tasks within the expected timeframe - Collaborates regularly with nursing staff and adjusters to provide status updates on task completion - Administers referrals for operating units and Nurse Case Managers - Sets tasks for Nurse Case Managers and self in each assigned case and monitors tasks daily for timely completion - Bills for all time spent within the appropriate cases - Updates injured worker demographic and/or attorney information, work status and/or network provider information when needed or as requested - Initiate, retrieve, coordinate and forward medical records to vendors, medical providers, adjusters, and Nurse Case Manager staff as requested - Requests verbally and/or in writing, medical notes, work status reports, and next office visit information with follow up communications to appropriate parties as information is obtained or when barriers occur to provide status updates - Confirm medical appointments, therapy visits, translation/transportation visits as requested by the Nurse Case Manager - Create and send out letter(s) to the injured worker and appropriate parties, as clarified by the Nurse Case Manager based upon state jurisdiction and legal representation demands - Document essential functions completed within the assigned file per established policies and procedures - Practice strict confidentiality in the handling of all data and communications in the performance of daily tasks - Coordinate and successfully complete specific projects and initiatives as directed - Solicits and incorporates suggestions from other team members to improve and streamline workflow - Attend training sessions and meetings in-person and virtually as needed
ID
2022-7160
Primary Location
US-MA-Boston
Loc2
Massachusetts
Loc3
Maine
Loc4
New Hampshire
Company Berkley Medical Management Solutions
Location Name AZ, Scottsdale - 7233 E Butherus Drive
The Telephonic Nurse Case Manager will assess, plan, coordinate, monitor, evaluate and implement options and services to facilitate timely medical care and return to work outcomes of injured workers.   Key functions include but are not limited to the following: - Coordinate and implement medical case management to facilitate case closure - Assess appropriate utilization of medical treatment and services available through contact with physicians and other specialist 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 - 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 - Coordinate job analysis with employer to facilitate return to work - Perform other duties and special projects as assigned by case management manager - Occasionally attend on site meetings and professional programs - Review job analysis with physician - Exhibit strong communication skills, flexibility and adaptability - Foster a teamwork environment - Documentation of cost savings - Meeting or exceeding productivity standards - Meeting or exceeding quality improvement standards
ID
2022-7159
Primary Location
US-AZ-Scottsdale
Loc2
MA, Boston - 99 Summer Street

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