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The Clinical Care Specialist (CCS) will work collaboratively with nurses and other professional staff members to support the daily functions of the clinical operations department. They will access multiple systems to obtain necessary documentation for processing. Responsibilities also include:
- Effective communication with nursing staff, adjusters, providers, injured workers, and any other parties involved in a case to obtain/confirm information and ensure case needs are clearly understood.
- Timely requests for medical notes and other case information including effective follow through.
- Completion of case tasks within the expected timeframe.
- Effective collaboration with nursing staff and adjusters when unable to complete tasks timely.
Essential functions include:
- Manage referrals for Operating Unit and/or Case Manager.
- Set tasks for TCM and self in each assigned case. Monitor tasks on daily basis for timely completion.
- Bill for all time spent within the appropriate cases.
- Update demographic or attorney information, work status and/or network provider information when needed or as requested.
- Initiate, retrieve, coordinate and forward medical records to vendors, providers, case managers staff as requested
- Request verbally and/or in writing, medical notes, work status, and next office visit information with follow up communications to appropriate parties as information is obtained or when barriers occur.
- Confirm medical appointments, therapy visits, translation/transportation visits as requested by the Case Manager.
- Create and send out letter(s) to the injured employee and appropriate parties, as clarified by the 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 as needed and approved
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