Cost Mitigation Nurse/ RN - #9805139
We help the world see new possibilities and inspire change for better tomorrows. Our analytic solutions bridge content, data, and analytics to help business, people, and society become stronger, more resilient, and sustainable.
The Mitigation Specialist is responsible for review of medical treatment records and development of cost containment strategies as related to workers’ compensation claims. Helpful experience includes case management skills, exposure to the workers’ compensation industry, preparing Medicare Set Asides and knowledge of CMS review/approval process. Strong writing skills, analysis, critical thinking skills, flexibility, and application of guidelines are required for this position. The Mitigation Specialist reports to the Director of Cost Mitigation and works closely with our attorneys, nurses, and Outreach Team to develop a plan for cost reduction in the WCMSA. The role involves effective communication regarding treatment plans with healthcare providers.
About the Day-to-Day Responsibilities of the Role
• Collaborates with a team of service attorneys and medical professionals in identifying mitigation opportunities for injury claims.
• Review of Medicare Set Aside, medical records and injury claim documents to develop a plan to reduce allocations in the Medicare Set Aside.
• Utilizes provided pricing tools to properly compare pricing of cost-effective medication or treatment alternatives.
• Abide by jurisdictional guidelines in contacts with providers or injured party.
• Use internal proprietary information technology tools to apply in daily use in preparing letters and templates to providers to facilitate and achieve cost saving measures.
• Communicates professionally and effectively with insurance adjusters, defense counsel, and plaintiff council regarding progress on Outreach efforts.
• Reviews impact and properly documents provider responses and/or medical documentation obtained.
• Maintains communication with Director on status of mitigation.
• Provides additional analysis and medical recommendations as needed.
• Completes updated MSA allocations to reflect changes accomplished through the provider outreach cost mitigation process.
• Occasional travel (<10% of the time)
About You and How You Can Excel in This Role
- Bachelor’s Degree, Associate Degree, or Diploma in Nursing required
- 3-5 years’ experience in Nursing required
- RN license in good standing with the applicable Board of Nursing required
- Experience in preparing Medicare Set Asides and exposure to CMS decisions on CMS submissions a plus
- Certification in the following a plus: Medicare Set-aside Certified Consultant (MSCC) and/or Certified Case Manager (CCM)
- Strong interpersonal, oral, and written communication skills required, including report preparation and communication with clients, providers, and attorneys
- Ability to work effectively both independently and as a member of a team
In 2022, Verisk received Great Place to Work Certification for our outstanding workplace culture for the sixth year in a row and second-time certification in the UK, Spain, and India. We’re also one of the 38 companies on the UK’s Best Workplaces list and one of 18 companies on Spain’s Best Workplaces list.
For over fifty years and through innovation, interpretation, and professional insight, Verisk has replaced uncertainty with precision to unlock opportunities that deliver significant and demonstrable impact. From our historic roots in risk assessment, we’ve grown to provide analytic insights that help transform industries focused on some of the world’s most critical areas. Today, the insurance industry relies on Verisk to be, and to make the world, more productive, resilient, and sustainable.
Verisk works in collaboration with our customers and at the intersection of people, data, and advanced technologies. Through proprietary platformed analytics, advanced modeling, and interpretation, we deliver immediate and sustained value to our customers and through them, to the individuals and societies they serve, with greater speed, precision, and scale.
We’re 9,000 people strong, committed to translating big data into big ideas. We help others see new possibilities and empower certainty into big decisions that impact individuals and societies. And we relentlessly and ethically pursue innovation to help move our customers, and the world, toward better tomorrows.
Everyone at Verisk—from our chief executive officer to our newest employee—is guided by The Verisk Way, to Be Remarkable, Add Value, and Innovate.
• Be Remarkable by doing something better each day in service to our customers and each other
• Add Value by delivering immediate and sustained results that drive positive outcomes
• Innovate by redefining what’s possible, embracing challenges, and pushing boundaries
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At Verisk you can build an exciting career with meaningful work; create positive and lasting impact on business; and find the support, coaching, and training you need to advance your career. We have received the Great Place to Work Certification for the 7th consecutive year. We’ve been recognized by Forbes as a World’s Best Employer and a Best Employer for Women, testaments to our culture of engagement and the value we place on an inclusive and diverse workforce. Verisk’s Statement on Racial Equity and Diversity supports our commitment to these values and affecting positive and lasting change in the communities where we live and work.
Verisk Analytics is an equal opportunity employer.
All members of the Verisk Analytics family of companies are equal opportunity employers. We consider all qualified applicants for employment without regard to race, religion, color, national origin, citizenship, sex, gender identity and/or expression, sexual orientation, veteran's status, age or disability.
Unsolicited resumes sent to Verisk, including unsolicited resumes sent to a Verisk business mailing address, fax machine or email address, or directly to Verisk employees, will be considered Verisk property. Verisk will NOT pay a fee for any placement resulting from the receipt of an unsolicited resume.