Nurse - Medical Case Manager
Company: Crawford & Co.
Posted on: May 3, 2021
This is a work from home position requiring local field case
management travel to cover the Charleston, WV
The candidate must be a Licensed RN and have a National
Workers Compensation/Case Management experience
effective 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 Assurance (QA) Guidelines to patients/employees
who are receiving benefits under an Insurance Line including but
not limited to Workers' Compensation, Group Health, Liability and
- Reviews case
records and reports, collects and analyzes data, evaluates injured
worker/disabled individual’s medical status, identifies needs and
obstacles to medical case resolution and RTW by providing proactive
case management services.
- Render opinions
regarding case costs, treatment plan, outcome and problem areas,
and makes recommendations to facilitate case management goals to
ability to meet administrative requirements, including
productivity, time management and QA standards, with a minimum of
- May perform job
site evaluations/summaries to facilitate case management
timely return to work date by establishing a professional working
relationship with the injured worker/disabled individual,
physician, and employer. Coordinate RTW with injured worker,
employer and physicians.
contact and communicates with claims adjusters to apprise them of
case activity, case direction or secure authorization for
services. Maintains contact with all parties involved on
case, necessary for case management the injured worker/disabled
- May obtain
records from the branch claims office.
- May review
files for claims adjusters and supervisors for appropriate referral
for case management services.
- May meet with
employers to review active files.
- Makes referrals
for Peer reviews and IME’s by obtaining and delivering medical
records and diagnostic films, notifying injured worker/disabled
individual and conferring with physicians.
clinical expertise and medical resources to interpret medical
records and test results and provides assessment
- 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 obtain
- Upholds the
Crawford and Company Code of Business Conduct at all
excellent customer service, and respect for customers, co-workers,
approaches problem solving by appropriate use of research and
- May perform
other related duties as assigned.
Associate’s degree or relevant course
work/certification in Nursing is required.
Minimum of 3-5
years diverse clinical experience and one of the below
as a case manager from the URAC-approved list of
(or higher) degree in a health or human services related
nurse (RN) license.
licensure in the state(s) the incumbent works in.
specific licensing requirements to provide medical case management
Minimum of 1
National Certification (CCM, CDMS, CRRN, and COHN) is
required. 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.
entail approximately 70% of work time.
a valid driver’s license in state of residence.
working knowledge of case management practices and ability to
quickly learn and apply workers compensation/case management
products and services.
and written communications skills to effectively facilitate
return-to-work solutions within a matrix organization and ensure
timely, quality documentation.
analytical and customer service skills to facilitate the resolution
of case management problems.
skills including working knowledge of Microsoft Office products and
ability to establish collaborative working relationships with
claims adjusters, employers, patients, attorneys and all levels of
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
Respect our culture of integrity and ethical
behavior, while embracing the unique talents of the individual and
encouraging an ownership mentality among everyone.
Empowered to advance
the company mission and take ownership of our individual career
through a corporate culture in which employees are good stewards of
Training and an
environment where employees continually seek and share knowledge
and are engaged and satisfied with their work.
Crawford, embracing a global mindset that’s inclusive,
agile, mission-focused, and customer-focused.
participating in an environment where people are rewarded for jobs
- Embody an
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
In addition to
a competitive salary, Crawford offers you:
advancement potential locally, nationally and internationally.
Crawford & Company has more than 700 locations in 70
training opportunities through every stage of your
benefits package including matching 401k; health, dental, and life
insurance; employee stock purchase plans; tuition reimbursement and
so much more.
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
Keywords: Crawford & Co., Charleston , Nurse - Medical Case Manager, Other , Charleston, West Virginia
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