Telephonic Case Manager - On-Site

Berkley Medical Management Solutions Portland, ME 2017-03-19
Berkley Medical Management Solutions is a specialized unit of W.R. Berkley Insurance Group. 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.

DUTIES

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

  • 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.
  • 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 supervisor.
  • Review job analysis with physician.
  • 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.
Associates are expected to model outstanding customer service behaviors.

  • Promote 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
  • 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
  • Know and exceed client expectations; get to know our clients, understand situations from the client's perspective, and deliver solutions specific to the client's needs.
  • Create a team approach by leveraging the culture of trust and openness, educating associates on each discipline and their role in supporting the organization, aligning responsibilities with the strengths of the individual team members, and taking responsibility for keeping the team informed and closing the loop.
QUALIFICATIONS

  • Graduate of an accredited school of nursing and possess a current RN license required. BSN preferred.
  • One (1) of the following Certifications highly preferred: CCM, CRRN, CDMS, COHN, CRC
  • Multiple Certifications preferred
  • Applicable state certifications in the state where job duties are performed.
  • 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.
  • 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)
  • Minimum of two (2) year experience in insurance rehabilitation and medical/vocational rehabilitation preferred.
  • 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 Spanish and English a plus