Sr. Medical Case Manager (CA) - Hybrid
Company: Crawford & Company
Location: San Bernardino
Posted on: March 16, 2023
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Job Description:
Excellence In Everything We Touch:
Position Summary:
--- Great Work Life Balance!
--- Monthly Bonus Program!
--- Free CEU's for licenses and certificates
--- License and national certification reimbursement
This is a work from home position requiring local field case
management travel.
Candidates must reside within the San Bernardino, CA region.
RN required and National Certification highly preferred!
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
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.
Responsibilities:
May assist supervisor/manager in review of reports, staff
development.
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 or surpass administrative
requirements, including productivity, time management, quality
assessment (QA) standards with a minimum of supervisory
intervention.
Facilitates a timely return to work date by establishing a
professional working relationship with the client, physician and
employer. Coordinates 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
notifying patients.
Manages cases of various product lines of at least 3-4 areas of
service (W/C, Health, STD, LTD, Auto, Liability, TPA, Catastrophic,
Life Care Planning). Specifically, the case manager should be
experienced in catastrophic cases plus 2-3 additional types listed
above.
Renders opinions regarding case cost, treatment plan, outcome, and
problem areas and makes recommendations to facilitate
rehabilitation goals and RTW.
May review files for claims adjusters and supervisors.
May perform job site evaluations/summaries. Prepares monthly
written evaluation reports denoting case activity, progress and
recommendations in accordance with state regulations and company
standards.
May obtain referrals from branch claims office or assist in
fielding phone calls for management as needed.
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 rehabilitation of the client.
May spend approximately 70% of work time traveling to homes, health
care providers, job sites, and various offices as required to
facilitate return to work and resolution of cases.
May meet with employers to review active files.
Reviews cases with supervisor monthly to evaluate file and obtain
direction.
Upholds the Crawford Code of Business Conduct at all times.
Demonstrates excellent customer service, and respect for customers,
co-workers, and management.
Independently approaches problem resolution by appropriate use of
research and resources.
May perform other related duties as assigned.
Requirements:
Bachelor's Degree in a health-related field is preferred.
Associates or diploma in nursing also accepted.
Three years of Workers' Compensation case management with ability
to independently coordinate a diverse caseload ranging in moderate
to high complexity.
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 without
restrictions with the State Board of Nursing.
Minimum of 1 nationally recognized Certification from the URAC list
of approved certifications.
Must be able to travel as required.
Individuals who conduct initial clinical review possess an active,
professional license or certification:
To practice as a health professional in a state or territory of the
U.S.; and
With a scope of practice that is relevant to the clinical area(s)
addressed in the initial clinical review.
Must maintain a valid driver's license in state of residence.
Demonstrated ability to handle complex assignments and ability to
work independently is required.
Effective oral and written communication skills are required.
Thorough understanding of jurisdictional WC statutes.
Advanced knowledge to exert positive influence in all areas of case
management.
Advanced communications and interpersonal skills in order to
conduct training, provide mentorship, and assist supervisor in
general areas as assigned.
Highly skilled at promoting all managed care products and services
internally and externally.
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 a part of the One
Crawford family.
Our total compensation plans provide each of our employees with far
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 while enhancing job performance
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, 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.%19213616% %%service%%
Keywords: Crawford & Company, San Bernardino , Sr. Medical Case Manager (CA) - Hybrid, Executive , San Bernardino, California
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