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 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 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 Clinical Manager, Medical Bill Review & Product Development, you will be an essential member of the workers’ comp managed care and cost containment team. You’ll be responsible for daily operations of clinical medical bill review services, developing and implementing new products and programs to improve patient outcomes and drive business success. The ideal candidate for this position will have strong clinical nursing acumen, managed care operations, as well as a managed care product development background, excellent communication skills, leadership experience, and a strategic mindset. The candidate will have comprehensive understanding of workers’ comp regulatory compliance and medical billing procedures, and they will be able to work closely with the IT team, claims professionals, patients, and other stakeholders to ensure the proper execution of necessary protocols. They will also possess excellent organizational skills, attention to detail, and strong analytical abilities to review medical bills, identify discrepancies, and provide feedback to the billing department.

• Management and coordination of clinical medical bill review operations, ensuring proper documentation, coding, and program effectiveness
• Develop and document clinical protocols, conduct clinical studies, and ensure compliance with regulatory requirements
• Provide education and training to clinical/medical bill review teams and external stakeholders
• Be the subject matter expert of nurse and code review products
• Coordinate with cross-functional teams to develop rules and other technical automation
• Work closely with IT and OU (client) teams to ensure successful product launches and promote product adoption among target audiences
• Implement and evaluate product development enhancements and outcome metrics
• Collaborate with physicians, pharmacists, and other healthcare professionals to ensure the integration of clinical knowledge into product development
• Monitor emerging trends in the healthcare industry and provide recommendations for product development based on market analysis and product performance data
• Conduct market research to identify new opportunities for product development within the managed care industry
• Provide timely coaching and feedback to drive and manage individual and team performance
• Assess talent, identify employee development and training needs, and collaborate with HR partner, leadership and team members to establish goals and create development plans
• Partner with HR and senior leadership to execute talent management strategies to improve employee engagement, job satisfaction, and foster a psychologically safe work environment

Qualifications

Education

• Bachelor's degree in Nursing required; Master’s degree preferred

Core Competencies

• Business Knowledge – Understands how polices, processes, metrics and industry trends impacts the business today and in the future.
• Critical Thinking – Uses rigorous logic and methods to solve difficult problems and looks for solutions in all areas.
• Directing Work – Sets clear objectives, clearly assigns responsibilities, provides direction and monitors process, progress and results.
• Operational Effectiveness – Dedicated to providing the highest quality products and services. Is committed to continuous improvement.
• Results Oriented – A relentless determination to get things done. Is business results focused and motivates and pushes others to achieve

Skills/Experience

• Active, unencumbered, nursing license.
• 5+ years of experience in medical bill review, clinical research, product development, or related field(s).
• Professional medical bill coder; CPC designation preferred
• 3+ years team leadership experience
• Vendor management experience preferred
• Strong analytical, problem-solving, and project management skills.
• Excellent communication, leadership, and collaboration abilities.
• Familiarity with regulatory requirements related to workers’ compensation clinical product development.
• Knowledge of managed care industry trends and emerging technologies
• Ability to effectively prioritize and manage time to meet deadlines

Travel Requirements

• Domestic U.S. travel required (up to 10% of time)

Additional Company Information

The Company is an equal employment opportunity employer

Additional Company Details

We do not accept unsolicited resumes from third party recruiting agencies or firms.

The company offers a competitive compensation plan and robust benefits package for full time regular employees.

Additional Requirements

While performing the duties of this job, the employee is regularly required to be seated for sustained periods of time; be able to use a keyboard; pick-up, pinch, or twist objects; must be able to communicate information accurately; distinguish sounds at normal levels and be able to receive information orally. The employee is occasionally required to move about the office to accomplish tasks; reach in any direction; raise or lower objects or move objects from place to place; and hold onto objects. Occasionally, the employee may need to move or exert force up to ten (10) pounds. The employee is regularly required to operate a computer and other office equipment, including a phone, copier and printer.

Job Type: Full-time

Pay: $80,000.00 - $120,000.00 per year

Benefits:

• 401(k)
• Health insurance
• Paid time off
• Tuition reimbursement

Schedule:

• 8 hour shift
• Monday to Friday

Work Location: Remote

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