Position Summary:
To facilitate quality case management services in an appropriate, cost effective manner. Provides medical case management service which is consistent with Utilization Review Accreditation Commission standards and Case Management Society of America Standards of Practice and Broadspire Quality Improvement Guidelines to patients/employees who are receiving benefits under an Insurance Line including but not limited to Workers' Compensation, Group Health, Liability and Disability.
YWORDS: nurse, field case manager, occupational health nurse, insurance, employee health, office nurse, return to work, injured worker, registered nurse, nursing, work from home, claims, claim, adjuster, examiner, benefits, cmsa, complex case, health, medical, practitioner, home health, orthopedics, neurology, surgical, spanish, bilingual, bi-lingual
* This position requires No Weekends! No Evenings! and No Shifts!
* You will be able to work from a home based position with full-time benefits and bonus opportunities!
* And this is a 40hour benefited position that is not based on case load!
Responsibilities:
* Reviews case records and reports, collects and analyzes data, evaluates client's medical and vocational status and defines needs and problems in order to provide proactive case management services.
* Demonstrates ability to meet administrative requirements, including productivity, time management and quality improvement standards, with a minimum of supervisory intervention.
* Renders opinions regarding case costs, treatment plan, outcome and problem areas, and makes recommendations to facilitate rehabilitation goals and return to work.
* Performs job site evaluations/summaries; prepares monthly written evaluative reports, denoting case activity, progress and recommendations in accordance with state regulations and standards.
* Facilitates timely return to work date by establishing a professional working relationship with the client, physician, and employer. Coordinate return to work with patient, employer and physicians.
* May recommend and facilitate completion of peer reviews and Independent Medical Examinations by obtaining and delivering medical records and diagnostic films as well as conferring with physicians both in person and on phone.
* May review files for claims adjusters and supervisors.
* Maintains contact and communicates with insurance adjusters to apprise them of case activity, case direction or receive authorization for services. Maintains contact with all parties involved on case, necessary for case management for the client.
* May obtain referrals from branch claims offices.
* Utilizing experience and medical resources interprets medical records and test results and provides assessment accordingly. Utilizes nursing process, case management standards of practice guidelines and Broadspire's Quality Improvement Guidelines in providing medical case management services.
* May meet with employers to review active files.
* Meets monthly production requirements and quality assessment requirements to ensure a quality product.
* Travels to homes, health care providers, and various offices as required facilitating return to work and resolution of cases. (Approximately 70% of a Medical Case Manager's position is spent in local travel).
* Reviews case with supervisor monthly to evaluate files and obtain directions.
OFFICIAL JOB TITLE: Medical Case Manager
Requirements:
* Associate s degree or relevant course work/certification in Nursing
* Three (3) years clinical experience preferably in Orthopedics, Neurology, Intensive Care, Occupational Medicine, or a related health care discipline.
* Valid RN licensure in the state(s) the incumbent works in.
* Must meet specific licensing requirements to provide medical case management services
* Career Advancement Potential locally, nationally and internationally. Crawford & Company has more than 700 locations in 70 countries
* World Class Training opportunities through every stage of your career
Crawford & Company participates in E-Verify and is an Equal Opportunity Employer. M/F/D/V
Crawford & Company is not accepting unsolicited assistance from search firms for this employment opportunity. All resumes submitted by search firms to any employee at Crawford via-email, the Internet or in any form and/or method without a valid written Statement of Work in place for this position from Crawford HR/Recruitment will be deemed the sole property of Crawford. No fee will be paid in the event the candidate is hired by Crawford as a result of the referral or through other means.
Employer's Job# 16216 - C
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