Nurse Case Manager, biBERK Insurance Services, Omaha, NE
biBERK Insurance Services -
N/A
Omaha, NE,
US
N/A
Nurse Case Manager
Date Posted: 2024-06-25
Job description
The Nurse Case Manager collaborates with Workers' Compensation claims representatives, medical providers, employers and injured employees to develop treatment plans focused on return to work and achieving maximum medical improvement within established medical and disability guidelines. This is achieved through overseeing all medical aspects of work-related injury claims by implementing the nursing process, including assessment, planning, coordination, intervention and evaluation. In collaboration with claims representatives, the Nurse Case Manager will be responsible for developing medical and disability management strategies for an assigned caseload within jurisdictional requirements. Caseload severity may range from medical only to catastrophic/complex claims across multiple jurisdictions. The Nurse Case Manager will also complete liability nurse reviews and serve as a clinical resource to Commercial Auto and Liability claims teams. This position will report to the Workers' Compensation Claims Manager.
Location: This is a full-time remote position. This position may require occasional travel to attend trainings and/or other related department meetings.
Job Responsibilities
Triage incoming Workers' Compensation claims and assign claims to claims staff based on injury severity
Provide medical case management through telephonic communication with injured employees, physicians, employers, health care providers, vocational rehabilitation consultants and others
Effectively manage caseload of medical/disability cases to achieve optimal outcomes and facilitate claim resolution
Evaluate injured employees' responses to medical treatment and using clinical expertise, recommend alternative treatment or care options as needed
Estimate medical treatment and recovery time guidelines to assist Claims with evaluating claim reserves
Serve as a clinical resource to claims staff
Protect the confidentiality of protected health information and other confidential information
Work with employers and physicians to develop modified job duties when practical to facilitate early return to work
Request and review medical records and treatment plans for appropriateness and medical necessity
Review pharmacy portal for medication management
Educate injured workers on treatment plans as needed to enhance adherence to the treatment plan and monitor progress towards maximum medical improvement
Collaborate with claims representative for utilization review services as appropriate
Clinically evaluate the recovery needs of an injured employee including discharge planning needs and facilitate referrals to durable medical equipment, transportation and home health vendors as applicable
Effective documentation of nurse case management activities, including activity updates and medical and disability case management strategies
Schedule independent medical exams or second opinions as appropriate, as well as routine medical appointments as required by jurisdiction
Maintain regular contact with injured employees, claims representatives, providers and employers to ensure understanding of the treatment plan by all parties
Obtain approval for injured employee contact on represented cases
Assist in negotiating pricing for medical equipment and medical services as needed
Apply advanced knowledge of injuries, comorbidities, medications, and treatment options to provide guidance on the treatment plan
Partner with claims representatives on coordination of treatment and services under the policy as allowed by the jurisdiction
Regularly communicate with injured employee and providers. Encourage the injured employee to participate in the recovery plan.
Identify injury and disability triggers requiring the engagement of field nurse case management
Complete referrals to field vendors and partner with vocational rehabilitation specialists and field nurse case managers to achieve optimal claim outcomes
Complete Liability Nurse Reviews on Commercial Auto and Liability claims with a goal of flagging missing records and inconsistencies in records, identifying co-morbid and non-related conditions, addressing causation/mechanism of injury, and evaluating medical records for excessive/duplicative/or unrelated treatment
Assist with department training needs
Additional duties and special projects as assigned
Duties are not limited to the above and may expand over time
Qualifications
Licensed Registered Nurse with a current unrestricted license in a compact nursing state required (Applicants with unrestricted nursing licenses in the following states will be considered: Alabama, Arizona, Arkansas, Colorado, Delaware, Florida, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Mississippi, Missouri, Montana, Nebraska, New Hampshire, New Jersey, New Mexico, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Vermont, Virginia, West Virginia, Washington, Wisconsin, Wyoming)
Certification as a CCM, CIRS, or other Case Management certification, where required (If not certified, must obtain within one year of hire)
3+ years clinical experience, preferably in orthopedics, rehabilitation, critical care, or emergency room
Ability to work independently and collaboratively within a virtual office environment
Excellent verbal and written communication skills
Must have reliable internet
Self-motivated and flexible
Strong customer service skills
Excellent written and verbal communication skills
Ability to independently manage workload, including prioritizing, and managing assignments to meet deadlines
Proficiency with MS Word, Excel, Outlook, Teams, Slack, Zoom and internet applications
Highly attentive to details
Able to work under pressure and execute good judgment in sensitive situations
About BHDIC:
biBerk is where small business owners can obtain commercial insurance coverage from insurers of the Berkshire Hathaway group of Insurance Companies, one of the best capitalized insurance groups in the world. Our ultimate parent, Berkshire Hathaway Inc. (berkshirehathaway.com) is a holding company with diversified interests in a host of industries, including insurance, energy, transportation and manufacturing. Most policies issued through biBERK.com will be underwritten by Berkshire Hathaway Direct Insurance Company ("BHDIC"), which is an AM Best rated A++ insurer.
BHDIC is domiciled in Omaha, Nebraska. BHDIC and the team at biBERK are focused on helping small business owners quickly and easily buy affordable insurance directly from a financially strong insurance company they can trust.
Some highlights of our benefits are:
Great work environment with growth opportunity
Competitive compensation
Generous amounts of vacation and sick time
Closed on major holidays
401(k) with company match
A fantastic healthcare package
Tuition reimbursement after 6 months of employment
In accordance with pay transparency laws and regulations, the following good faith compensation range estimate is being provided. The starting salary range for this position is $80,000 to $95,000 per year. Final compensation will be based on candidate qualifications, geographic location, and other considerations permitted by law.