Medical Case Manager - CA
Company: Crawford & Company
Location: Modesto
Posted on: April 15, 2024
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Job Description:
Excellence In Everything We Touch:Position Summary:--- Great
Work Life Balance!--- Monthly Bonus Program!--- Free CEU's for
licenses and certificates--- License and national certification
reimbursementThis is a work from home position requiring local
field case management travel to cover the Modesto, CA
region.National Certification such as CCM, CRC, COHN, CRRC
preferred.RN degree required.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.Based on federal, state, or local law, this position may
require you to be fully vaccinated for COVID-19. If required, the
hiring manager will discuss with you during your interview
process.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.--- 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.--- 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.---
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
salaryPay and incentive plans that recognize performance
excellenceBenefit programs that empower financial, physical, and
mental wellnessTraining programs that promote continuous learning
and career progression while enhancing job
performanceSustainability programs that give back to the
communities in which we live and workA culture of respect,
collaboration, entrepreneurial spirit and inclusionCrawford &
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-KE1
Keywords: Crawford & Company, Ceres , Medical Case Manager - CA, Executive , Modesto, California
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