Crawford & Company · 1 month ago
Telephonic Case Manager
United States
Full-time
Remote
Entry, Mid Level
1+ years expCrawford & Company is a global leader in claims management, seeking an RN Telephonic Case Manager to provide effective case management services. The role involves delivering medical case management consistent with industry standards and supporting patients receiving benefits under various insurance lines.
Insurance
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
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
Qualification
Required
Must hold a multi-state Nursing License
Residing in a compact state
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
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
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 required
Must reside in a compact state and must hold multi state Nursing License
Preferred
National Certification preferred (CCM, CRC, COHN, CRRC)
Workers' Comp Case Management experience a plus
Benefits
Quarterly Bonus Opportunities
Free CEUs for licenses & certificates
License & Certification Reimbursement
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
Company
Crawford & Company
Based in Atlanta, GA Crawford & Company(R) (www.crawco.com) is the world's largest publicly listed independent provider of claims management and outsourcing solutions to carriers, brokers and corporates, with an expansive global network serving clients in more than 70 countries.
10001+ employees
Funding
Current Stage
Late StageLeadership Team
Larry Thomas
EVP - CEO Crawford U.S. Services
Bruce Swain
EVP - Chief Financial Officer
Recent News
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