May assist supervisor/manager in review of reports, staff development.
Reviews case 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.
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 by obtaining and delivering medical records and diagnostic films notifying patients.
Manages cases 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 above.
Renders opinions regarding case cost, treatment plan, outcome, and problem areas and makes recommendations to facilitate rehabilitation case management goals to include 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 company standards.
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.
May spend 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.
Reviews cases with supervisor monthly to evaluate file and obtain direction.
Bachelor’s degree in a health-related field is required.
Three years of Workers’ Compensation case management experience.
Demonstrated ability to handle complex assignments and ability to work independently is required.
Thorough understanding of jurisdictional WC statutes.
Advanced knowledge to exert positive influence in all areas of case management.
Advanced communications and interpersonal skills in order to conduct training, provide mentorship, and assist supervisor in general areas as assigned.
Must maintain a valid driver’s license in state of residence.
Valid RN licensure in the state(s) the incumbent works in.
Minimum of 1 nationally recognized National Certification (CCM, CDMS, CRRN, or COHN) credentials.
Must be able to travel as required.
Individuals who 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.; and with a scope of practice that is relevant to the clinical area(s) addressed in the initial clinical review.
Internal Number: 2017-1871
About Broadspire by Crawford & Company
Broadspire is Crawford's Third-Party Administrator (TPA) specializing in servicing the claims needs of corporations, brokers and insurers who wish to take greater control over the claims process, indemnity spend, data capture, and to access meaningful management information.
Our successful medical and vocational case managers exude empathy, flexibility, problem solving and communication skills. If our mission, to restore and enhance lives, businesses and communities supports why you chose the medical industry, we have a career opportunity for you! Our medical and vocational case managers support Crawford’s vision by evaluating, counseling, medically assessing and coordinating return to work plans for patients who are receiving benefits under an Insurance Line including but not limited to worker’s compensation, group health, liability and/or disability.
Many of our positions are work from home and we would love for your to join our team!