Nurse - Medical Case Manager (CA) - PT
Company: Crawford & Company
Location: San Bernardino
Posted on: September 13, 2019
Excellence In Everything We TouchPosition SummaryThis is a PT work
from home position requiring ?local field case management travel.?
Must reside within the San Bernardino, CA region.?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.?Responsibilities?
- 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
- Facilitate timely return to work date by establishing a
professional working relationship with the client, physician, and
employer.? Coordinate RTW with patient, employer and
- 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
- 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
- Utilizes experience and medical resources to interpret medical
records and test results and provides assessment accordingly.
- May spend approximately 70% of their work time traveling to
homes, health care providers, job sites and various offices as
required facilitating RTW and resolution of cases.
- Meets monthly production requirements and quality assessment
(QA) requirements to ensure a quality product.
- Reviews cases with supervisor monthly to evaluate files and
- Upholds the Crawford Code of Business Conduct at all
- Demonstrates excellent customer service, and respect for
customers, co-workers, and management.
- Independently approach problem resolution by appropriate use of
research and resources.
- May perform other related duties as assigned.??Requirements??
- Associate?s degree or relevant course work/certification in
Nursing is required
- Minimum of 3-5 years diverse clinical experience and one of the
- Certification as a case manager from the URAC-approved list of
- A bachelors (or higher) degree in a health or human services
- A registered nurse (RN) license.
- Valid RN licensure in the state(s) the incumbent works in.
- Must meet specific licensing requirements to provide medical
case management services.
- Minimum of 1 National Certification (CCM, CDMS, CRRN, and COHN)
is highly preferred.? If not attained, must plan to take
certification exam within proceeding 24 months and have a minimum
of 4 years WC case management experience/demonstrated excellent
performance in a similar position with another organization.
- Travel may entail approximately 70% of work time.
- Must maintain a valid driver?s license in state of
- 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.
- Basic computer skills including working knowledge of Microsoft
Office products and Lotus Notes.
- Demonstrated ability to establish collaborative working
relationships with claims adjusters, employers, patients, attorneys
and all levels of employees.?
- Demonstrated ability to gather and analyze data and establish
plans to improve trends, processes, and outcomes.
- Excellent organizational skills as evidenced by proven ability
to handle multiple tasks simultaneously.
- Demonstrated leadership ability with a basic understanding of
supervisory and management principles.?Preferred:
- BSN Degree is preferred.??About Us?Think all TPAs are the same?
Think again. With Broadspire, our leading global third-party
administrator (TPA), Crawford & Company is the consultative
outsourcing partner that adapts to businesses? needs and challenges
at any point of the claims processing journey. We offer casualty
claim and medical management services to assist large organizations
in achieving their unique goals, increasing employee productivity
and reducing the cost of risk through professional expertise,
technology and data analytics.As part of the One Crawford family,
Broadspire brings together the best and brightest people in the
industry to deliver smart, thoughtful solutions to our clients, and
we are guided by our collective value system: RESTORE.At Crawford,
- Respect our culture of integrity and ethical behavior, while
embracing the unique talents of the individual and encouraging an
ownership mentality among everyone.
- Are Empowered to advance the company mission and take ownership
of our individual career progression.
- Promote Sustainability through a corporate culture in which
employees are good stewards of their communities.
- Emphasize Training and an environment where employees
continually seek and share knowledge and are engaged and satisfied
with their work.
- Are One Crawford, embracing a global mindset that?s inclusive,
agile, mission-focused, and customer-focused.
- Give Recognition, participating in an environment where people
are rewarded for jobs well done.
- Embody an Entrepreneurial Spirit, sharing a passion to succeed,
innovate, and outpace our competitors.We believe in leading by
example ? at work and in our communities. 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 mission, vision and
values. Learn more at www.crawfordandcompany.com.In addition to a
competitive salary, Crawford offers you:
- Career advancement potential locally, nationally and
internationally. Crawford & Company has more than 700 locations in
- On-going training opportunities through every stage of your
- Strong benefits package including matching 401k; health,
dental, and life insurance; employee stock purchase plans; tuition
reimbursement and so much more.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.
Keywords: Crawford & Company, San Bernardino , Nurse - Medical Case Manager (CA) - PT, Executive , San Bernardino, California
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