Medical Case Mgr-Seasonal

About the role

We're seeking an RN with a passion for case management to join our team. The ideal candidate must have an RN degree from Florida or Georgia, and a National Certification (CCM, CRC, COHN, CRRC) is required.

Responsibilities

• Reviews case records and reports, collects and analyzes data, evaluates medical status, and identifies needs and obstacles to medical case resolution and RTW.
• Provides opinions regarding case costs, treatment plan, outcome, and problem areas, and makes recommendations to facilitate case management goals to include RTW.
• 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.
• 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.
• Spend approximately 70% of work time traveling to homes, health care providers, job sites and various offices as required to facilitate RTW and resolve 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.

Qualifications

• 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.
• 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 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.
• Maintain a valid driver's license in state of residence.

Benefits

We offer a comprehensive Total Rewards package to our employees, including competitive base pay, bonus/incentive pay and other performance-based rewards, if applicable. Our benefits package includes:

• Medical, Dental and Vision Plans
• Paid holidays, vacation and sick leave
• 401(k) Retirement Plan
• Tuition Assistance
• Paid Parental Leave
• Supplemental Health Benefits
• Enhanced Mental Health Support
• Virtual Physical Therapy
• Caregiving Services
• Life Assistance Program

The above information highlights some of the benefits currently available to eligible full-time employees. Crawford & Company participates in E-Verify and is an Equal Opportunity Employer. M/F/D/V