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Berkley Medical Management Solutions has an opening for a Nurse Case Manager to join the team! The role will assess, plan, coordinate, monitor, evaluate and implement options and services to facilitate timely medical care and return to work outcomes of injured workers. The Nurse Case Manager promotes exceptional service by identifying interaction opportunities, taking ownership of client results, providing high quality service, managing response times, using judgment, and building from both small and large successes. The role will enhance communications by being proactive, engaging in active listening, asking questions to determine underlying needs, and stopping and analyzing the situation; learn from problems and implement preventative measures for the future.
Nurse Case Managers know and exceed client expectations and gets to know our clients, understanding situations from our client's perspective, and delivering solutions specific to our client's needs.
Responsibilities include but are not limited to:
- 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
*This is a remote opportunity with the goal of having someone located in the North East or Midwest.
The Clinical Production Manager provides guidance, analytics, insights and leadership to our clinical management team while managing the day to day production workflows and processes for all products. Critical interactions may involve our technology providers, informatics, internal and external partners or other industry organizations and direct production management of our internal clinical team. Major accountabilities include but are not limited to:
- Partners with executive leaders to lead the adoption of technology, clinical partners or workflows that are innovative, interoperable, patient-centric, user friendly and focused on quality and cost effective outcomes.
- Champions the redesign of clinical production workflows to support the business in meeting internal and client goals.
- Educates non-clinical staff on clinical processes so safe, patient centric, and user friendly systems can be designed.
- Develops clinical educational resources that include critical thinking, workflow and care process changes and not just use of the health technology.
- Demonstrates the use of tact and discretion in all communications and provide a positive contribution to the morale of the department
- Establishes and maintains effective working relationships with unit staff, clients, providers, and other departments of BMMS
- Clinical data analysis to provide understanding and effectiveness of programs and claimant outcomes to internal and external stakeholders
- Clinical Program system support and usability
- Development of enhancements to current clinical programs with an emphasis on production management
- Interaction with and management of our internal clinical operations team
- Work with our clinical case management team to leverage information and data insuring proper clinical decision making
- Development of productivity management reporting for leadership
- Educate internal and external peers and colleagues on clinical concerns, issues or trends
- Drive best-practice adoption across the organization as it relates to clinical management program to achieve the best outcomes for claimants served
- Anticipates customer needs and proactively develops solutions to meet them
- Solves complex problems and develops innovative solutions.
- Provides explanations and information to others on productivity issues.
- Forecasts and plans resource requirements.
- Authorizes deviations from standards.
- Reviews work performed by others and provides recommendations for improvement.
- Motivates and inspires other team members.
- Hold round tables with the clinical team, as well as the operating units
- Create and present monthly trend and comparison reports