Medical Case Manager - Hybrid - Case Management
Company: Crawford & Company
Location: Chicago
Posted on: March 20, 2023
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Job Description:
Medical Case Manager - HybridExcellence 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 to cover the Chicago, IL region.
* National Certification such as CCM, CRC, COHN, CRRC preferred
* RN degree preferred or comparable case management experience with
RN degree
* Prior Workers Compensation Case Management preferred
To provide 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, Disability, and Care Management.
Responsibilities
* 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 include RTW.
* Demonstrates ability to meet administrative requirements,
including productivity, time management and QA standards, with a
minimum of supervisory intervention.
* May perform job site evaluations/summaries to facilitate case
management process.
* Facilitates 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.
* Maintains 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 individual.
* 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.
* Utilizes clinical expertise 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
obtain directions.
* Upholds the Crawford and Company Code of Business Conduct at all
times.
* Demonstrates excellent customer service, and respect for
customers, co-workers, and management.
* Independently approaches problem solving 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; BSN Degree is preferred.
* Minimum of 1-3 years diverse clinical experience and one of the
below:
* Certification as a case manager from the URAC-approved list of
certifications (preferred);
* A registered nurse (RN) license.
* Must be compliant with state requirements regarding national
certifications.
* 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.
* Must meet specific requirements to provide medical case
management services.
* Minimum of 1 National Certification (CCM, CDMS, CRRN, and COHN)
is preferred. If not attained, must plan to take certification exam
within proceeding 36 months.
* National certification must be obtained in order to reach Senior
Medical Case Management status.
* Travel may entail approximately 70% of work time.
* Must maintain a valid driver's license in state of residence.
* 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.
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.
#LI-SM
Keywords: Crawford & Company, Chicago , Medical Case Manager - Hybrid - Case Management, Executive , Chicago, Illinois
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