Crawford & Company Registered Nurse Senior Medical Case Manager in Castle Rock, Colorado

REGISTERED NURSE - SENIOR MEDICAL CASE MANAGERRequisition ID 2017-1548Job LocationsUS-CO-Colorado SpringsUS-CO-Cannon CityUS-CO-PuebloUS-CO-Highlands RanchUS-CO-Castle RockPosted Date 6/19/2017CategoryMedical Case ManagementBusiness Unit Broadspire MORE INFORMATION ABOUT THIS JOB EXCELLENCE IN EVERYTHING WE TOUCH POSITION SUMMARY This is a work from home position requiring local field case managementtravel To provide quality case management services in an appropriate, costeffective manner. Provides medical case management service which is consistentwith URAC standards and CMSA Standards of Practice and Quality ImprovementGuidelines to patients/employees who are receiving benefits under anInsurance Line including but not limited to Workers' Compensation, GroupHealth, Liability and Disability. RESPONSIBILITIES * May assist supervisor/manager in review of reports, staffdevelopment. * Reviews case records and reports, collects and analyzesdata, evaluates client's medical and vocational status and defines needsand problems in order to provide proactive case management services. * Demonstrates ability to meet or surpass administrativerequirements, including productivity, time management, qualityassessment (QA) standards with a minimum of supervisory intervention. * Facilitates a timely return to work date by establishing aprofessional working relationship with the injured worker/disabledindividual, physician and employer. Coordinates return to work with injuredworker/disabled individual, employer and physicians. * May recommend and facilitate completion of peer reviews andIME s by obtaining and delivering medical records and diagnostic filmsnotifying patients. * Manages cases of various product lines of at least 3-4 areasof service (W/C, Health, STD, LTD, Auto, Liability, TPA,Catastrophic, Life Care Planning). Specifically, the case managershould be experienced in catastrophic cases plus 2-3 additional types listedab * Renders opinions regarding case cost, treatment plan,outcome, and problem areas and makes recommendations to facilitaterehabilitation case management goals to include RTW. * May review files for claims adjusters and supervisors. * May perform job site evaluations/summaries. Preparesmonthly written evaluation reports denoting case activity, progress andrecommendations in accordance with state regulations and company standards. * May obtain referrals from branch claims office or assist infielding phone calls for management as needed. * Maintains contact and communicates with insurance adjustersto apprise them of case activity, case direction or receive authorizationfor services. Maintains contact with all parties involved on case,necessary for rehabilitation of the client. * May spend approximately 70% of work time traveling tohomes, health care providers, job sites, and various offices as requiredto facilitate return to work and resolution of cases. * May meet with employers to review active files. * Reviews cases with supervisor monthly to evaluate file andobtain direction. * Upholds the Crawford and Company Code of Business Conduct atall times. * Demonstrates excellent customer service, and respect forcustomers, co-workers, and management * Independently approaches problem resolution by appropriateuse of research and resources. * May perform other related duties as assigned. REQUIREMENTS Bachelor s degree in a health-related field is required. Three years of Workers Compensation case management with ability toindependently coordinate a diverse caseload ranging in moderate to highcomplexity. Valid RN licensure in the state(s) the incumbent works in. Minimum of 1 nationally recognized Certification from the URAC list ofapproved certification