Clinical Care Specialist - Remote, Must Be Located In Pacific Standard Time

MUST BE PHYSICALLY LOCATED IN THE US PACIFIC STANDARD TIME ZONE.

Berkley Medical Management Solutions (BMMS) provides a different kind of managed-care service for W.R. Berkley Corporation. We believe focusing on an injured worker’s successful and speedy return to work is good for people and good for Berkley’s insurance operating units. BMMS was first started in 2014 by reimagining the relationship between medical need and technology as a way to deliver the best outcome for injured workers and Berkley’s operating units. Our goal was clear: combine solid clinical practices, proven return-to-work strategies and robust software into one system for seamless management of workers’ compensation cases.

To get it right, we started with a flexible technology platform that allowed for impressive customization without sacrificing the ability for expansion and continued innovation. We deploy integrated systems to give W.R. Berkley Companies recommendations and professional services for managing each individual case in an efficient and appropriate manner. The power of our technology takes medical bill-review services and clinical advisory services to a new level. Our unique marriage of technology, software platforms, data analytics and professional services ensures we provide Berkley’s operating units with reliable results, and reduced time and expenses associated with case management.

Responsibilities

As a Clinical Care Specialist (CCS), you will work collaboratively with nurse case managers and other professional staff members to support the daily functions of the managed care department. You will coordinate, monitor and evaluate treatment plans designed to optimize timely medical care and return to work outcomes for each injured worker, and access multiple systems and work with medical providers to obtain necessary documentation for processing.

• Effectively and professionally communicate with nursing staff, adjusters, medical providers, injured workers, and any other parties involved in a case to obtain and confirm information, and ensure case needs are clearly understood
• Complete timely requests for medical notes and other case information from medical providers, including effective follow through to secure the documentation in a timely fashion
• Completion of case tasks within the expected timeframe
• Collaborates regularly in a professional and courteous manner with nursing staff and adjusters to provide status updates on task completion
• Complete and submit referrals to vendors, maintain and track statuses
• Sets tasks for Nurse Case Managers and self in each assigned case and monitors tasks daily for timely completion
• Updates injured worker demographic and/or attorney information, work status and/or network provider information when needed or as requested
• Initiate, retrieve, coordinate and forward medical records to vendors, medical providers, adjusters, and Nurse Case Manager staff as requested
• Requests verbally and/or in writing, medical notes, work status reports, and next office visit information with follow up communications
• Confirm medical appointments, therapy visits, translation/transportation as requested by the Nurse Case Manager
• Create and send out letter(s) to the injured worker and appropriate parties
• Document completed tasks within the assigned file per established policies and procedures
• Practice strict confidentiality in the handling of all data and communications in the performance of daily tasks
• Coordinate and successfully complete specific projects and initiatives as directed
• Incorporates suggestions from other team members to improve and streamline workflow
• Attend training sessions and meetings in-person and virtually as needed

Qualifications

Skills and Experience

• Preferred knowledge of medical terminology, medical codes and criteria used in treatment procedures, state workers’ compensation rules & regulations, and general knowledge of managed care concepts or willingness to learn
• Strong verbal and written communication skills
• Demonstrates professionalism and tact in all communications
• Experience as an EMT, Medical Office Assistant, and/or knowledge of Medical Terminology preferred
• Strong computer skills and working knowledge of Microsoft Office suite of products (Word, Excel, PowerPoint, Outlook)
• Strong attention to detail

Education

• High School diploma or GED required

Travel Requirements

• Domestic U.S. travel is required (up to 5% of time)

Additional Company Details

The Company is an equal employment opportunity employer

Additional Company DetailsThe Company is an equal employment opportunity employer.

www.berkleymms.com

We do not accept any unsolicited resumes from external recruiting agencies or firms.

The company offers a competitive compensation plan and robust benefits package for full time regular employees. This is an hourly role paying between $22/hr to $25/hr.

The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other

The application window for this role is estimated to be open through February 29, 2024, but may be extended if necessary. Please submit your application as soon as possible prior to that date.

Job Type: Full-time

Pay: $22.00 - $25.00 per hour

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Employee assistance program
• Health insurance
• Health savings account
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• Day shift
• Monday to Friday

Work Location: Remote