Illinois Workers Compensation Telephonic Nurse Case Manager

About the Role

The day-to-day responsibilities of this role will include coordinating and implementing medical case management, communicating with employers, adjusters, and injured workers, and assessing the appropriate utilization of medical treatment and services. You will work closely with physicians and other specialists to ensure that injured workers receive cost-effective, quality care. Your expertise and judgment will be essential in making recommendations to achieve case progress and movement towards closure.

Berkley's commitment to innovation and customer satisfaction sets it apart in the industry. By combining advanced technology with clinical expertise, the company provides seamless and efficient case management services. As a Telephonic Nurse Case Manager, you will be integral to this process, working closely with the case management leadership team to ensure that all aspects of case management are thoroughly addressed.

What You Will Do

• Assess, plan, coordinate, monitor, evaluate, and implement options and services to facilitate timely medical care and return to work outcomes for injured workers.
• Coordinate and implement medical case management to facilitate case closure.
• Communicate timely and comprehensively with employers, adjusters, and injured workers.
• Assess the appropriate utilization of medical treatment and services through contact with physicians and other specialists.
• Review and analyze medical records and data to ensure the appropriate case management process occurs, providing recommendations to achieve case progress and movement to closure.
• Manage 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, evaluating cost-effectiveness and quality of services.
• Document activities and case progress using appropriate methods and tools, following best practices for quality improvement.
• Review job analysis/job description with all providers to coordinate and implement disability case management.
• Engage and participate in special projects as assigned by the case management leadership team.
• Occasionally attend on-site meetings and professional programs.
• Foster a teamwork environment and maintain evidence-based medical guidelines in reference to the injured worker treatment plan and work status.

What We Are Looking For

• Minimum of 2 years of experience in workers' compensation insurance and medical case management (preferred).
• Minimum of 4 years of medical/surgical clinical experience required.
• Strong communication skills, professionalism, flexibility, and adaptability.
• Working knowledge of medical and vocational resources available to the Workers’ Compensation industry.
• Evidence of self-motivation and the ability to perform case management duties independently.
• Evidence of computer and technical skills.
• Ability to obtain and maintain applicable state certifications and/or licensures in the state where job duties are performed.
• Ability to obtain case management professional certification (CCM) within 2 years of hire date.
• Earn Continuing Education Units to maintain certifications and licensures.

Nice to Have

• Experience with home services, durable medical equipment, and vocational services.
• Knowledge of workers' compensation laws and regulations in multiple states.
• Familiarity with case management software and technology platforms.
• Certification in a related field, such as occupational health.

Benefits and Perks

• Competitive salary and benefits package.
• Opportunity to work with a dynamic and innovative company.
• Professional development and growth opportunities.
• Flexible and remote work arrangements.
• Access to cutting-edge technology and tools.
• Collaborative and supportive team environment.
• Comprehensive health insurance and wellness programs.
• Generous paid time off and holiday policy.

• To stand out in your application, emphasize your experience with case management software and technology platforms, as well as your knowledge of workers' compensation laws and regulations.
• Highlight any certifications you hold, such as CCM, and your commitment to ongoing education and professional development.
• Prepare to discuss specific examples of your experience in managing complex cases, including how you coordinate with multiple stakeholders and ensure timely and cost-effective care.
• Be ready to talk about your approach to staying current with medical guidelines and best practices, and how you apply these in your daily work.
• Consider creating a portfolio or portfolio equivalent that showcases your case management skills and experience, including any positive outcomes or testimonials from previous employers or clients.
• When discussing salary, be prepared to negotiate based on your research of the market rate for similar positions, and be open to discussing non-monetary benefits that are important to you, such as flexible work arrangements or professional development opportunities.