To provide quality case management services in an appropriate, cost effective manner. Provides medical case management service which is consistent with URAC standards and CMSA Standards of Practice and Broadspire Quality Improvement (QI) Guidelines to patients/employees who are receiving benefits under an Insurance Line including but not limited to Workers' Compensation, Group Health, Liability and Disability.
- Reviews case records and reports, collects and analyzes data, evaluates client's medical status and defines needs and problems in order to provide proactive case management services.
- Render opinions regarding case costs, treatment plan, outcome and problem areas, and makes recommendations to facilitate rehab goals and RTW.
- Demonstrates ability to meet administrative requirements, including productivity, time management and QI standards, with a minimum of supervisory intervention.
- May perform job site evaluations/summaries to facilitate case management process.
- Facilitate timely return to work date by establishing a professional working relationship with the client, physician, and employer. Coordinate RTW with patient, employer and physicians.
- 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 records from the branch claims office.
- May review files for claims adjusters and supervisors.
- May meet with employers to review active files.
- Peer reviews and IME’s by obtaining and delivering medical records and diagnostic films, notifying patients’ and conferring with physicians.
- Utilizes experience and medical resources to interpret medical records and test results and provides assessment accordingly.
- Travels to homes, health care providers, job sites and various offices as required facilitating RTW and resolution of cases. (Approximately 70% of an OSCM’s position is spent in travel.)
- Meets monthly production requirements and quality assessment (QA) requirements to ensure a quality product.
- Reviews cases with supervisor monthly to evaluate files and obtain directions.
- May perform other related duties as assigned.
- RN license in good standing
- Associate’s degree or relevant course work/certification in Nursing is required
- Three (3) years clinical experience preferably in Orthopedics, Neurology,
Intensive Care, Occupational Medicine, or related health care discipline.
- General working knowledge of case management practices and ability to quickly learn and apply workers compensation/case management products and services.
- Excellent oral and written communications skills to effectively facilitate return-to-work solutions within a matrix organization and ensure timely, quality documentation.
- Excellent analytical and customer service skills to facilitate the resolution of case management problems.
- Demonstrated ability to establish collaborative working relationships with claims adjusters, employers, patients, attorneys and all levels of employees.
- Bachelor's Degree in Nursing (BSN)
- CCM, COHN, CRRN or CDMS certification
- Bilingual Spanish a plus but not required
In addition to a competitive salary, Crawford offers you:
Crawford & Company participates in E-Verify and is an Equal Opportunity Employer. M/F/D/V
- Career advancement potential locally, nationally and internationally. Crawford & Company has more than 700 locations in 70 countries
- On-going training opportunities through every stage of your career
- Strong benefits package including 401k; health, dental, and life insurance; employee stock purchase plans; tuition reimbursement and so much more.
- Work from Home !!!
- Travel & Mileage Reimbursement !!!
- Weekday Schedule !!!
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.
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Crawford & Company - 10 months ago