This is a work from home position requiring local field case management travel.
To provide 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 Broadspire' 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 Disability.
May assist supervisor/manager in review of reports, staff development.
Reviews case records and reports, collects and analyzes data, evaluates injured worker/disabled individual’s medical and vocational status. Identifies needs and obstacles in order to provide proactive case management services.
Performs various duties including vocational evaluation, counseling, medical assessment and coordinate return to work.
Demonstrates ability to meet or surpass administrative requirements, including productivity, time management, quality assessment (QA) standards with a minimum of supervisory intervention.
Facilitates a 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.
May recommend and facilitate completion of peer reviews and IME’s.
Manages cases of various product lines of services (W/C and Health)
Knowledge of multiple product lines such as STD, LTD, Auto, Liability, Catastrophic, and Life Car Planning is a plus but not required.
Renders opinions regarding treatment plans, outcomes and problem areas and makes recommendations to facilitate case management goals and RTW.
May review 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 Broadspire' standards.
May obtain referrals from branch claims office or assist in fielding phone calls for management as needed
Maintains 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.
Travels 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.
Reviews cases with supervisor monthly to evaluate file and obtain direction.
May perform other related duties as assigned.
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 system: RESTORE.
At Crawford, we:
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 www.crawfordandcompany.com.
In addition to a competitive salary, Crawford offers you:
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.