Medical Case Manager Ii
Crawford and Company (Boston, Massachusetts)

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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 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:

1.     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.

2.     Render opinions regarding case costs, treatment plan, outcome and problem areas, and makes recommendations to facilitate rehab goals and RTW.

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

4.     May perform job site evaluations/summaries to facilitate case management process.

5.     Facilitate timely return to work date by establishing a professional working relationship with the client, physician, and employer. Coordinate RTW with patient, employer and physicians.

6.     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.

7.     May obtain records from the branch claims office.

8.     May review files for claims adjusters and supervisors.

9.     May meet with employers to review active files.

10.     Peer reviews and IME’s by obtaining and delivering medical records and diagnostic films, notifying patients’ and conferring with physicians.

11.     Utilizes experience and medical resources to interpret medical records and test results and provides assessment accordingly.

12.     Travels to homes, health care providers, job sites and various offices as required facilitating RTW and resolution of cases. (Approximately 70% of an OSCM’s position is spent in travel.)

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

14.     Reviews cases 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.

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.

Experience:

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

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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