Nurse Case Manager- The World Bank

Job Locations US-DC-Washington, DC
Posted Date 1 month ago(1/18/2018 11:21 AM)
Requisition ID
2018-3097
Category
Medical Case Management
Business Unit
Broadspire

Excellence In Everything We Touch

Broadspire Med Management

Position Summary

 

The World Bank Nurse Case Manager review all claims once established in the claim system. The Nurse Case Manager will provide direction, education and guidance relative to clinical and vocational components of each claim.  In addition, the Nurse Case Manager will oversee or perform medical case management and coordination of services provided to ill or injured staff members of the World Bank Group (WBG) and adhere to the Staff Rules which guide the disability and workers’ compensation program.

 

 

Responsibilities

 

  • Reviews, analyzes and makes recommendations based on medical documents
  • Contacts medical providers to verify clinical information, identify factors that may influence the length of disability, and discuss options to return to work as appropriate
  • Consults with treating physician(s)and employer representative(s) to negotiate the return of staff members to employment
  • Assess medical information and makes disability determinations based on the staff member’s functional capacity in comparison to the functional requirements of his/her job
  • May confer with  WBG to evaluate the work environment and to determine the possibility of the staff member’s return to their former position
  • Identifies safety concerns within the home environment to ascertain possible barriers to rehabilitation process via conversations with the staff member.
  • Notifies referral sources when injured worker’s condition is not feasible for return to work.
  • Recommends and monitors job site modifications to accommodate the staff members’ residual physical abilities, if required.
  • Makes recommendations for IME’s as appropriate
  • Coordinates as needed with WBGs Health Services Department (HSD) for all items regarding clinical case management and workplace accommodation.
  • Coordination of clinical field staff (nurses and vocational specialists)  for on-site non-occupational and occupational claims assessment and management as needed.
  • Coordinates IME’s and/or Physician Reviews as appropriate
  • Maintains adherence to all WBG’s special handling instructions, pertinent laws, advocacy, ethical, safety, regulations, and confidentiality standards.
  • Upholds the Crawford Code of Business Conduct at all times
  • Utilizes evidenced based medicine when performing claim reviews
  • Acts as a medical management resource for claim examiners, case managers and WBG
  • Identify, formulate, and implement training / educational programs as needed to support the quality of the WBG’s disability program
  • Upholds the Crawford Code of Conduct

 

Requirements

 

  • RN state licensure in good standing with the State Board of Nursing
  • Minimum of two years Case Management experience. 
  • Minimum eight years of clinical expertise preferably in a varied clinical environment.
  • Advanced certification in case management or other clinically relevant area (i.e. CCM, CRRN, ABQUAR, CPHQ, COHN, or QRP) is required.
  • Maintain state licenses as requested.
  • Must be able to travel as required.
  • Expertise in analytical problem solving,
  • Decision making with sound judgment, good organizational and time management skills, and excellent verbal and written communication skills.
  • Fluent speaking, writing and reading in a second language – preferably, French, Spanish, or German.
  • Must type 30 words per minute. 
  • Must posses a working knowledge of computers with the ability to use standard word processing, excel, and software applications. 
  • Effectively utilizes desktop tools to conform to State jurisdictional guidelines and account specific criteria. 
  • Exhibits a proven knowledge of multiple product lines and services. 
  • Subject matter expert on Broadspire’s medical management services.  Demonstrates a proficiency in State Jurisdictional Guidelines and Account Specific criteria as applicable.

 

About Us

 

Broadspire (www.choosebroadspire.com), a leading international third party administrator, provides risk management solutions designed to help clients improve their financial results. Broadspire offers 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 a Crawford Company, Broadspire is based Atlanta, Ga., with 85 locations throughout the United States. Services are offered by Crawford & Company under the Broadspire brand in Europe (www.Broadspire.eu), including the United Kingdom (www.BroadspireTPA.co.uk).

In addition to a competitive salary, Crawford offers you:

  • Career advancement potential locally, nationally and internationally. Crawford & Company has more than 700 locations in 70 countries;
  • On-going training opportunities through every stage of your career
  • Strong benefits package including matching 401k; health, dental, and life insurance; employee stock purchase plans; tuition reimbursement and so much more.

Crawford & 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 means. 

 

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