[Hiring] Telephonic Case Manager @Crawford & Company

Role Description

We're seeking a compassionate and experienced RN Telephonic Case Manager to join our growing team.

• Provide impactful case management services to help patients and employees navigate their healthcare journey.
• Work within URAC standards, CMSA Standards of Practice, and Broadspire QA Guidelines to ensure quality care.

Responsibilities

• Review case records and reports, collect and analyze data, and evaluate injured worker/disabled individual's medical status.
• Identify needs and obstacles to medical case resolution and return to work (RTW) by providing proactive case management services.
• Render opinions regarding case costs, treatment plans, outcomes, and problem areas; make recommendations to facilitate case management goals, including RTW.
• Demonstrate ability to meet administrative requirements, including productivity, time management, and QA standards.
• Facilitate timely return to work dates by establishing professional relationships with injured workers, physicians, and employers.
• Maintain communication with claims adjusters regarding case activity and direction.
• Obtain records from branch claims offices and review files for appropriate referrals for case management services.
• Make referrals for peer reviews and IMEs by obtaining and delivering medical records and diagnostic films.
• Utilize clinical expertise to interpret medical records and test results.
• Meet monthly production and quality assessment requirements.
• Review cases with supervisor monthly to evaluate files and obtain directions.
• Uphold the Crawford and Company Code of Business Conduct at all times.
• Demonstrate excellent customer service and respect for customers, co-workers, and management.
• Independently approach problem-solving using appropriate research and resources.
• Perform other related duties as assigned.

Qualifications

• Active Multi-State RN License; must reside in a Compact State.
• National Certifications preferred: CCM, CRC, COHN, or CRRC.
• Workers' Compensation Case Management experience is highly valued.
• Associate's degree or relevant coursework/certification in Nursing is required; BSN Degree is preferred.
• Minimum of 1-3 years diverse clinical experience.
• Certification as a case manager from the URAC-approved list of certifications (preferred) or a registered nurse (RN) license.
• General working knowledge of case management practices.
• Excellent oral and written communication skills.
• Excellent analytical and customer service skills.
• Basic computer skills including working knowledge of Microsoft Office products and Lotus Notes.
• Demonstrated ability to establish collaborative working relationships.
• Demonstrated ability to gather and analyze data and establish plans to improve trends, processes, and outcomes.
• Excellent organizational skills.
• Demonstrated leadership ability with a basic understanding of supervisory and management principles.
• Active RN home state licensure in good standing without restrictions.
• Must meet specific requirements to provide medical case management services.
• Minimum of 1 National Certification (CCM, CDMS, CRRN, and COHN) is preferred; must plan to take certification exam within the next 36 months.

Benefits

• Competitive Compensation Based on Experience.
• Quarterly Performance Bonuses.
• Free CEUs for Ongoing Professional Development.
• License and Certification Reimbursement.
• Excellent Work-Life Balance.
• Medical, Dental and Vision Plans.
• Prescription Drugs.
• HSA, HRA, and FSA Accounts.
• 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.