W. R. Berkley Corporation

Manager

• 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
• Timely and comprehensive communication with employers, adjusters and the injured workers.
• 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
• Acquire and maintain nursing licensure for all jurisdictions as business needs require
• 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
• Reviewing job analysis/job description with all providers to coordinate and implement disability case management. This includes coordinating job analysis with employer to facilitate return to work.
• Engage and participate in special projects as assigned by case management leadership team
• Occasionally attend on site meetings and professional programs
• Foster a teamwork environment
• Maintaining and updating evidence based medical guidelines (such as Official Disability Guidelines, MD Guidelines and all required state regulated guidelines) in reference to the injured worker treatment plan and work status.
• Obtain and maintain applicable state certifications and/or licensures in the state where job duties are performed.
• Obtain case management professional certification (CCM) within 2 years of hire date
• Earn Continuing Education Units to maintain certifications and licensures

Telephonic Nurse Case Manager

Operations

• Serve as a subject-matter expert for Medical Bill Review (MBR) operations;
• Provide advanced production support and drive process improvements;
• Coordinate cross-functional issue resolution and project execution;
• Support processing of workers’ compensation medical and pharmacy bills from bill intake through payment;
• Investigate bill processing issues and problem-solve;
• Interface with multiple vendors for issue resolution;
• Monitor business dashboards and vendor reports daily for TAT trends;
• Recommend workflow enhancements and document trends and issues for improvement;
• Build and maintain relationships with internal teams, external vendors, and medical providers.

Workers Compensation, Medical Bill Review, Operations Analyst

• Serve as a subject-matter expert for Medical Bill Review (MBR) operations
• Providing advanced production support, driving process improvements, and coordinating cross-functional issue resolution and project execution
• Support the processing of workers’ compensation medical and pharmacy bills from bill intake through bill payment
• Work directly with Berkley Operating Units to investigate bill processing issues
• Responsible for problem-solving, identifying and triaging issues to technical teams
• Interface with multiple vendors to facilitate issue resolution, issue documentation, tracking, and reporting
• Independently and as part of a team identify issue commonalities and root causes to assist in solution design, monitoring, and controlling

Telephonic Nurse Case Manager

Workers Compensation, Medical Bill Review, Operations Analyst

Operations Analyst – Medical Bill Review