Overview Medical Case Manager role at Crawford & Company. Provides medical case management services in an appropriate, cost effective manner. Services are consistent with URAC standards, CMSA Standards of Practice, and Broadspire Quality Assurance guidelines for patients/employees receiving benefits under an Insurance Line (including but not limited to Workers' Compensation, Group Health, Liability, Disability, and Care Management).
Responsibilities Reviews case records and reports, collects and analyzes data, evaluates medical status of injured workers/disabled individuals, identifies needs and obstacles to medical case resolution and return-to-work (RTW) by providing proactive case management services.
Render opinions regarding case costs, treatment plans, outcomes, and problem areas; make recommendations to facilitate case management goals including RTW.
Meet administrative requirements, including productivity, time management, and QA standards, with minimal supervisory intervention.
May perform job site evaluations/summaries to facilitate the case management process.
Facilitates timely RTW by establishing professional relationships with the injured worker/disabled individual, physician, and employer; coordinate RTW with injured worker, employer, and physicians.
Maintain contact with claims adjusters to apprise them of case activity, direction, or authorization for services; communicate with all parties involved as needed for case management of the injured worker/disabled individual.
May obtain records from the branch claims office and review files for referral for case management services as appropriate.
May meet with employers to review active files and make referrals for peer reviews and IMEs by obtaining and delivering medical records and diagnostic films, notifying the injured worker/disabled individual and conferring with physicians.
Utilizes clinical expertise and medical resources to interpret medical records and test results and provide assessments accordingly.
May spend approximately 70% of work time traveling to homes, health care providers, job sites and offices to facilitate RTW and case resolution.
Meets monthly production and QA requirements to ensure a quality product.
Reviews cases with supervisor monthly to evaluate files and obtain directions.
Upholds Crawford & Company Code of Business Conduct; demonstrates excellent customer service and respect for customers, co-workers, and management.
Independently approaches problem solving using research and available resources; may perform other related duties as assigned.
Qualifications Associate's degree or relevant coursework/certification in Nursing required; BSN preferred.
Minimum 1-3 years diverse clinical experience; certification as a case manager from URAC-approved list (preferred) or RN license; must be compliant with state requirements regarding national certifications.
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 communication skills to facilitate return-to-work solutions within a matrix organization and ensure timely, quality documentation.
Excellent analytical and customer service skills to facilitate resolution of case management problems.
Basic computer skills including Microsoft Office and Lotus Notes.
Ability to establish collaborative working relationships with claims adjusters, employers, patients, attorneys, and all levels of employees; ability to gather and analyze data and establish plans to improve trends, processes, and outcomes.
Excellent organizational skills with proven ability to handle multiple tasks simultaneously; basic leadership understanding.
Based on federal, state, or local law, this position may require you to be fully vaccinated for COVID-19.
Active RN home state licensure in good standing with the State Board of Nursing; must meet specific requirements to provide medical case management services.
Minimum of 1 national certification (CCM, CDMS, CRRN, COHN) preferred; if not attained, plan to take certification exam within 36 months.
National certification must be obtained to reach Senior Medical Case Management status.
Travel may entail approximately 70% of work time.
Must maintain a valid driver's license in state of residence.
About Us Why Crawford? Because a claim is more than a number — it’s a person, a child, a friend. It’s anyone who looks to Crawford on their worst days. And by helping to restore their lives, we are helping to restore our community – one claim at a time. At Crawford, employees are empowered to grow, emboldened to act and inspired to innovate. Our industry-leading team pioneers new solutions for the industries and customers we serve. We’re looking for the next generation of leaders to take this journey with us. We hail from more than 70 countries and speak dozens of languages, reflecting the global fabric of the audience we serve. Though our reach is vast, we proudly operate as One Crawford: united in purpose, vision and values. Learn more at www.crawco.com. When you accept a job with Crawford, you become part of the One Crawford family.
Our total compensation plans provide each employee with more than just a great salary: pay and incentive plans that recognize performance excellence; benefit programs that empower financial, physical, and mental wellness; training programs that promote continuous learning and career progression; sustainability programs that give back to the communities in which we live and work; a culture of respect, collaboration, entrepreneurial spirit and inclusion.
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 or the Internet will be deemed the sole property of Crawford. No fee will be paid if the candidate is hired by Crawford as a result of the referral or through other means.