To facilitate 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.
OFFICIAL JOB TITLE : Medical Case Manager I - PT
- 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 QI 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 IME's 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 (QA) 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 an OSCM's position is spent in travel).
- Reviews case with supervisor monthly to evaluate files and obtain directions.
- May perform other related duties as assigned.
- CCM, COHN, CRRN or CDMS certification required
- 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
- 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.
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 matching 401k; health, dental, and life insurance; employee stock purchase plans; tuition reimbursement and so much more.
- Work from Home !!!
- Great Work/Life Balance !!!
- Flexibility to set own work schedule !!!
- Benefits plus Bonus Opportunities !!!
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.
Crawford & Company
- 2 years ago - save job