Medical Case Manager - Part-time Hourly at Hilton Head

Job Description

Based in Atlanta, Ga., Crawford & Company (www.crawfordandcompany.com) is the worlds largest independent provider of claims management solutions to the risk management and insurance industry as well as self-insured entities, with an expansive global network serving clients in more than 70 countries. The Crawford System of Claims SolutionsSM offers comprehensive, integrated claims services, business process outsourcing and consulting services for major product lines including property and casualty claims management, workers compensation claims and medical management, and legal settlement administration. The Companys shares are traded on the NYSE under the symbols CRDA and CRDB.

This is a 15 to 20 hour per week hourly work from home position with field case management travel involved.

Position Summary:

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:

• Reviews case records and reports, collects and analyzes data, evaluates clients medical and vocational status and defines needs and problems in order to provide proactive case management services.
  
• Demonstrates ability to meet administrative requirements, including productivity, time management and QI standards, with a minimum of supervisory intervention.
  
• Renders opinions regarding case costs, treatment plan, outcome and problem areas, and makes recommendations to facilitate rehabilitation goals and return to work.
  
• Performs job site evaluations/summaries; prepares monthly written evaluative reports, denoting case activity, progress and recommendations in accordance with state regulations and standards.
  
• 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.
  
• May recommend and facilitate completion of peer reviews and IMEs by obtaining and delivering medical records and diagnostic films as well as conferring with physicians both in person and on phone.
  
• May review files for claims adjusters and supervisors.
  
• 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.
  
• May obtain referrals from branch claims offices.
  
• 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 Broadspires Quality Improvement Guidelines in providing medical case management services.
  
• May meet with employers to review active files.
  
• Meets monthly production requirements and quality assessment (QA) requirements to ensure a quality product.
  
• Travels to homes, health care providers, and various offices as required facilitating return to work and resolution of cases. (Approximately 70% of an OSCMs position is spent in travel).
  
• Reviews case with supervisor monthly to evaluate files and obtain directions.
  
• May perform other related duties as assigned.

OFFICIAL JOB TITLE: Medical Case Manager - Seasonal

Job Requirements

Requirements:

• Associates degree or relevant course work/certification in Nursing
  
• Three (3) years clinical experience preferably in Orthopedics, Neurology, Intensive Care, Occupational Medicine, or a related health care discipline.
  
• Valid RN licensure in the state(s) the incumbent works in.
  
• Must meet specific licensing requirements to provide medical case management services
  
• General working knowledge of case management practices and ability to quickly learn and apply workers compensation/case management products and services.

Preferred:

• Bachelors Degree in Nursing (BSN)
• CCM, COHN, CRRN or CDMS certification a plus
• Previous Workers Compensation Case Management experience
• Bilingual Spanish a plus but not required

In addition to a competitive salary, Crawford offers you:

• Career advancement potential locally, nationally and internationally. Crawford & Company has more than 700 locations in70 countries.
• On-going training opportunities through every stage of your career.
• Strong benefits package including matching 401k; health, dental, and life insurance; employee stock purchase plans; tuition reimbursement and so much more.
• Work from Home !!!
• Travel & Mileage Reimbursement
• Weekday Hours!!!

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.

Country: USA, State: South Carolina, City: Hilton Head, Company: Broadspire.