Medical Resource Nurse (Workers Compensation)

Berkshire Hathaway Homestate Companies, Workers Compensation Division, has an immediate opening for a Medical Resource Nurse to join our Medical Management team! This medical professional will use their advanced knowledge, education, training, and experience to provide specialized technical expertise regarding medical information, advice, and training to our Claims Adjusting staff. This is an integral role in assisting us meet our mission in returning injured workers to health and the ability to return to work. If you're tired of floor work and ready for an opportunity to utilize your skills in a corporate environment, we'd love to speak with you!

ESSENTIAL RESPONSIBILITIES

• Provides expertise, advice, and alerts to Claims Professionals and others regarding medical issues in claims, including causation, diagnosis, prognosis, and the appropriateness and effectiveness of treatment. Consulting is initiated either upon request by the Claims Professional or pursuant to a program that includes claims meeting certain specific criteria. Successfully completes the training program covering the laws and procedures of workers’ compensation bill review.
• Develops or evaluates medical cost projections for use in claims reserving and settlement analysis, analyzing input from Medical Bill Review and Utilization Review to identify the likelihood and cost of possible future treatment. Participates in roundtable discussions regarding these valuations.
• Participates in strategic planning meetings regarding major claims, providing guidance and advice on the medical issues in the claims. Learns legal subjects, including relevant statutes, regulations, case law, and litigation processes.
• Facilitates discussion/review with Utilization Review and Claims Professionals to help monitor and guide the medical treatment provided to injured workers. Learns the concepts, terminology, and practices of workers’ compensation claims.
• Advises Claims Professionals to ensure Field Case Nurses are assigned in appropriate claims in a timely manner, are given clear assignments, perform their work effectively and efficiently, and are removed from claims when their objectives have been met or at the discretion of the Claims Professional.
• Prepares and delivers training to Claims staff on a variety of advanced medical topics.
• Assesses and records the quality of services provided by medical providers, in order to support the creation and continued improvement of high-quality provider panels and networks.
• Fosters a positive and close working relationship with other Company staff, including adjusting staff, Utilization Review, Medical Bill Review, Special Investigations Unit, Legal, Liens, Customer Care, and Client Services.
• Maintains patient confidentiality and safeguards protected health information in accordance with state and federal laws and Company policies.
• Attains and maintains a high level of current medical knowledge relating to the injuries and conditions most common in workers’ compensation claims, including new methods of diagnosis and treatment, as well as the treatment guidelines and other medical authorities relevant to the jurisdictions within the Medical Resource Nurse’s responsibilities.

REQUIRED QUALIFICATIONS

• EDUCATION – Bachelor of Science in Nursing (B.S.N.) degree, Registered Nursing (R.N.) degree, Associate in Nursing degree, or equivalent certificate required.
• CERTIFICATIONS AND LICENSES – Licensed Practical Nurse (L.P.N.) license, or equivalent education, required.
• EXPERIENCE: Minimum of 5 years experience in nursing required. Hospital nursing experience preferred. 
• TECHNICAL SKILLS – To perform this job successfully, an individual must have knowledge of currently recognized evidence-based medicine guidelines.
• COMPUTER SKILLS – Able to effectively use Microsoft Office/365 applications and be able to master and become proficient in proprietary and vendor software programs.
• LANGUAGE SKILLS – Able to read and understand basic documents, including statutes, regulations, medical records, medical bills, medical resource materials, claim notes, and claim data fields.  Able to write clear, concise reports accurately conveying complex and nuanced information, as well as correspondence on medical and legal points. Able to effectively present information and respond to questions with adjusting staff, Management, and others.
• MATH SKILLS – Able to calculate figures and amounts, such as discounts, interest, proportions, percentages, sums, differences, products, and volumes.

WHAT WE OFFER

• Work From Home (Up to 2 days per week upon eligibility)
• Onsite Gym
• Garage Parking
• Within walking distance of the Old Market District
• Paid Time Off
• Pai