Nurse - Senior Medical Case Manager
Company: Crawford & Co.
Posted on: May 3, 2021
This is a
remote position requiring local field case
management within the
Lafayette/Lake Charles Louisiana
with a National Certification and prior Workers Compensation Case
quality 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
Quality Improvement Guidelines to patients/employees who are
receiving benefits under an Insurance Line including but not
limited to Workers' Compensation, Group Health, Liability and
supervisor/manager in review of reports, staff
records and reports, collects and analyzes data, evaluates client's
medical and vocational status and defines needs and problems in
order to provide proactive case management services.
ability to meet or surpass administrative requirements, including
productivity, time management, quality assessment (QA) standards
with a minimum of supervisory intervention.
timely return to work date by establishing a professional working
relationship with the injured worker/disabled individual, physician
and employer. Coordinates return to work with injured
worker/disabled individual, employer and physicians.
and facilitate completion of peer reviews and IME’s by obtaining
and delivering medical records and diagnostic films notifying
of various product lines of at least 3-4 areas of service (W/C,
Health, STD, LTD, Auto, Liability, TPA, Catastrophic, Life Care
Planning). Specifically, the case manager should be
experienced in catastrophic cases plus 2-3 additional types listed
opinions regarding case cost, treatment plan, outcome, and problem
areas and makes recommendations to facilitate rehabilitation case
management goals to include RTW.
files for claims adjusters and supervisors.
May perform job
site evaluations/summaries. Prepares monthly written
evaluation reports denoting case activity, progress and
recommendations in accordance with state regulations and company
referrals from branch claims office or assist in fielding phone
calls for management as needed.
contact and communicates with insurance adjusters to apprise them
of case activity, case direction or receive authorization for
services. Maintains contact with all parties involved on
case, necessary for rehabilitation of the client.
approximately 70% of work time traveling to homes, health care
providers, job sites, and various offices as required to facilitate
return to work and resolution of cases.
May meet with
employers to review active files.
with supervisor monthly to evaluate file and obtain
Crawford and Company Code of Business Conduct at all
excellent customer service, and respect for customers, co-workers,
approaches problem resolution by appropriate use of research and
other related duties as assigned.
degree in a health-related field is required.
Three years of
Workers’ Compensation case management with ability to independently
coordinate a diverse caseload ranging in moderate to high
licensure in the state(s) the incumbent works in.
Minimum of 1
nationally recognized Certification from the URAC list of approved
Must be able to
travel as required.
conduct initial clinical review possess an active,
professional license or certification:
- To practice as
a health professional in a state or territory of the U.S.;
- With a scope of
practice that is relevant to the clinical area(s) addressed in the
initial clinical review.
- Must maintain a
valid driver’s license in state of residence.
ability to handle complex assignments and ability to work
independently is required.
- Effective oral
and written communication skills are required.
understanding of jurisdictional WC statutes.
knowledge to exert positive influence in all areas of case
communications and interpersonal skills in order to conduct
training, provide mentorship, and assist supervisor in general
areas as assigned.
- Highly skilled
at promoting all managed care products and services internally and
Think all TPAs
are the same? Think again. With Broadspire, our leading global
third-party administrator (TPA), Crawford & Company is the
consultative outsourcing partner that adapts to businesses’ needs
and challenges at any point of the claims processing journey. We
offer casualty claim and medical management services to assist
large organizations in achieving their unique goals, increasing
employee productivity and reducing the cost of risk through
professional expertise, technology and data analytics.
As part of the
One Crawford family, Broadspire brings together the best and
brightest people in the industry to deliver smart, thoughtful
solutions to our clients, and we are guided by our collective value
Respect our culture of integrity and ethical
behavior, while embracing the unique talents of the individual and
encouraging an ownership mentality among everyone.
Empowered to advance
the company mission and take ownership of our individual career
through a corporate culture in which employees are good stewards of
Training and an
environment where employees continually seek and share knowledge
and are engaged and satisfied with their work.
Crawford, embracing a global mindset that’s inclusive,
agile, mission-focused, and customer-focused.
participating in an environment where people are rewarded for jobs
- Embody an
Spirit, sharing a passion to succeed, innovate, and
outpace our competitors.
We believe in
leading by example – at work and in our communities. 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 mission,
vision and values. Learn more at
In addition to
a competitive salary, Crawford offers you:
advancement potential locally, nationally and internationally.
Crawford & Company has more than 700 locations in 70
training opportunities through every stage of your
benefits package including matching 401k; health, dental, and life
insurance; employee stock purchase plans; tuition reimbursement and
so much more.
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
Keywords: Crawford & Co., Lafayette , Nurse - Senior Medical Case Manager, Other , Lafayette, Louisiana
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