Medical Case Manager Hrly
Crawford and Company (Raleigh/Durham-RTP, North Carolina)

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Based in Atlanta, Georgia, Crawford & Company is the world's largest independent provider of claims management solutions to insurance companies and self-insured entities, with a global network of more than 700 offices in 63 countries. Major service lines include property and casualty claims management, legal settlement administration, including class action and warranty inspections, and risk management information services. Broadspire, a wholly owned subsidiary, offers a broad array of customized casualty, medical management, and integrated disability management. Crawford's shares are traded on the NYSE under the symbols CRDA and CRDB.

Summary of Role:

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.

Responsibilities:

1.     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.

2.     Demonstrates ability to meet administrative requirements, including productivity, time management and QI standards, with a minimum of supervisory intervention.

3.     Renders opinions regarding case costs, treatment plan, outcome and problem areas, and makes recommendations to facilitate rehabilitation goals and return to work.

4.     Performs job site evaluations/summaries; prepares monthly written evaluative reports, denoting case activity, progress and recommendations in accordance with state regulations and standards.

5.     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.

6.     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.

7.     May review files for claims adjusters and supervisors.

8.     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.

9.     May obtain referrals from branch claims offices.

10.     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.

11.     May meet with employers to review active files.

12.     Meets monthly production requirements and quality assessment (QA) requirements to ensure a quality product.

13.     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).

14.     Reviews case with supervisor monthly to evaluate files and obtain directions.

15.     May perform other related duties as assigned.

Education:

Associate’s degree or relevant course work/certification in Nursing is required; BSN Degree is preferred.

Knowledge and Skills:

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.

Experience:

3 years clinical experience preferably in Orthopedics, Neurology, Intensive Care, Occupational Medicine, or a related health care discipline.


Decision Making/Interaction:

May maintain average caseloads ranging from 25-30 active cases (number may vary).

Case management services include but are not limited to the facilitation of quality, appropriate medical services in a cost-effective manner.

Interventions of the Case Manager affects hard and soft savings which, when integrated
with the total managed care system, results in marketable quality product.

Special Requirements/Certifications/Requirements:

Valid RN licensure in the state(s) the incumbent works in.

Must meet specific licensing requirements to provide medical case management services.

Travel entails approximately 70% of work time.

Crawford offers excellent benefits, training and competitive salaries. If you are interested in joining a leader in the claims management industry, please apply now. EOE M/F/D/V

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