Nurse Case Manager Team Lead

This is an exciting, remote opportunity for an experienced R.N. with prior telephonic Workers’ Compensation case management experience to lead a telephonic nurse case management team and provide superior customer service to insureds and injured workers while handling a reduced case management caseload. The Team Lead will supervise a Workers’ Compensation nurse case management team providing nationwide telephonic nurse case management support to a rapidly growing Workers’ Compensation claims department. The nurse case management team oversees the medical aspects of work-related injuries, ensuring injured workers receive appropriate care while managing costs and facilitating a safe return to work. In collaboration with claims representatives, the nurse case management team is responsible for developing medical and disability management strategies for an assigned caseload within jurisdictional requirements. The nurse case management team also completes pharmacy benefit management for the Workers’ Compensation department and triages new Workers’ Compensation claims to ensure the right resources are assigned to a claim from the outset. Caseload severity ranges from medical only to catastrophic/complex claims across multiple jurisdictions.

Location: This is a full-time remote position and can be located anywhere in the United States if the candidate has a Compact+ RN license. The candidate must be willing to obtain non-Compact state licenses as needed (i.e. CA, DC, IL, MI, MN, & NY.) This position may require occasional travel to attend trainings and/or other related department meetings.

Job Responsibilities

The Team Lead- Nurse Case Management will be responsible for, but not limited to:

• Lead, supervise and support a telephonic nurse case management team completing claim triage, pharmacy benefit management, and case management services nationwide to achieve department goals by promoting compliance within regulatory and company guidelines
• Set priorities for the nurse case management team to ensure performance goals are met and drive consistency across the team
• Conduct weekly team meetings and regular check-in discussions with individual team members
• Monitor team performance, provide feedback, and conduct performance evaluations
• Manage a reduced pending of telephonic task and full case management Workers’ Compensation referrals; Provide medical case management through telephonic communication with injured employees, physicians, employers, health care providers, vocational rehabilitation consultants and others
• 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
• Implement a nurse case management audit process to drive consistency across the department; responsible for monitoring the quality of work produced and coaching team towards consistent and improved performance
• Participate in the recruitment, selection and hiring of team members
• Provide superior customer service and facilitate clear communication and collaboration among multiple parties, including the injured worker, employer, claims representative, legal, and healthcare providers
• Independently manage workload, including prioritizing cases and determining how to manage cases effectively
• Partner with Claims leadership to determine best practices and promote teamwork
• Serve as a nurse case management subject matter expert; participate in internal and external projects as needed
• Partner with Supervisor to identify training opportunities
• Mentor and train new team members, ensuring they are proficient in case management principles and procedures consistent with company best practices
• In a backup capacity, triage incoming Workers’ Compensation claims and assign claims to claims staff based on injury severity
• Report vendor changes or delays to ensure vendors meet service level agreement expectations
• Collect and evaluate data from multiple sources to monitor and improve nurse case management performance
• Identify, implement and manage process enhancements to improve overall team delivery of case management services to align with organizational goals
• 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
• 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
• Utilize external resources appropriately (field nurse case managers, durable medical equipment, vocational rehabilitation) to achieve optimal claim outcomes
• Develop strategies to facilitate an injured worker’s return to work and achieve maximum medical improvement with a focus on evaluating and updating disability dates within established protocols throughout the life of the claim

• Collaborate with claim representatives to provide guidance on medical treatment and disability duration to assist in evaluating claim reserves
• Effective documentation of nurse case management activities, including activity updates and medical and disability case management strategies
• Maintain regular contact with injured employees, claims representatives, providers and employers to ensure understanding of the treatment plan by all parties 
• Assist in negotiating pricing for medical equipment and skilled nursing facilities as needed
• Identify injury and disability triggers requiring the engagement of field nurse case management
• 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
• Duties are not limited to the above and may expand over time

Qualifications

Knowledge, Experience, and Abilities:

• 4+ years of telephonic Workers’ Compensation case management experience required
• Previous supervisory experience a plus
• Prior clinical experience preferred
• Knowledge of ODG, utilization review, and state workers’ compensation guidelines preferred
• Proven ability to mentor and train team members, fostering a collaborative and productive work environment
• Ability to work in a fast-paced, collaborative, virtual office environment
• Ability to multi-task and effectively prioritize tasks with frequent interruptions
• Superior interpersonal skills to develop positive rapport with internal/external stakeholders and provide superior customer service to insureds and injured workers
• Excellent written and verbal communication skills
• Strong analytical and organizational skills
• Superb time management skills with the capability of consistently working independently with minimal supervisor to meet deadlines
• Must demonstrate flexibility in a rapidly changing enviornment due to growth of the organization
• Written and verbal fluency in Spanish and English preferred

Required Education:

• Licensed Registered Nurse with an active, 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, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Vermont, Virginia, West Virginia, Washington, Wisconsin, Wyoming.) Must demonstrate willingness to obtain additional licenses in non-compact states. Authorized licensing expenses will be managed by the company for the selected candidate.
• BA/BS degree required
• Certification as a CCM, CIRS, or other Case Management certification, where required (If not certified, must obtain within one year of hire)

About Us

biBerk is where commercial insurance buyers can obtain coverage for their businesses 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
• Subsidized downtown parking (for in-office positions)
• 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
• Service recognition after 5 years of employment

In accordance with pay transparency laws and regulations, the following good faith compensation range estimate is being provided.  The salary range for this position is $105,000 - $125,000 per year.  Final compensation will be based on candidate qualifications, geographic location, and other considerations permitted by law.