Nurse - Senior Medical Case Manager (San Francisco CA)
Company: Crawford & Company
Location: San Leandro
Posted on: November 11, 2019
Excellence In Everything We Touch Position Summary This position is
home office based requiring 70% travel. Our candidate must reside
within the San Francisco, CA region. Company car available for
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 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. Responsibilities
- May assist supervisor/manager in review of reports, staff
- 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
- Demonstrates ability to meet or surpass administrative
requirements, including productivity, time management, quality
assessment (QA) standards with a minimum of supervisory
- Facilitates a timely return to work date by establishing a
professional working relationship with the client, physician and
employer. Coordinates return to work with patient, employer and
- 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
- Renders opinions regarding case cost, treatment plan, outcome,
and problem areas and makes recommendations to facilitate
rehabilitation 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 company
- 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.
- 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
- Upholds the Crawford Code of Business Conduct at all
- Demonstrates excellent customer service, and respect for
customers, co-workers, and management
- Independently approaches problem resolution by appropriate use
of research and resources.
- May perform other related duties as assigned. Requirements
- Bachelor's 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 complexity.
- Valid RN licensure in the state(s) the incumbent works in.
- Minimum of 1 nationally recognized Certification from the URAC
list of approved certifications.
- 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.
- Must maintain a valid driver's license in state of
- Demonstrated ability to handle complex assignments and ability
to work independently is required.
- Effective oral and written communication skills are
- Thorough understanding of jurisdictional WC statutes.
- Advanced knowledge to exert positive influence in all areas of
- Advanced 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 externally. About Us 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,
- Respect our culture of integrity and ethical behavior, while
embracing the unique talents of the individual and encouraging an
ownership mentality among everyone.
- Are Empowered to advance the company mission and take ownership
of our individual career progression.
- Promote Sustainability through a corporate culture in which
employees are good stewards of their communities.
- Emphasize Training and an environment where employees
continually seek and share knowledge and are engaged and satisfied
with their work.
- Are One Crawford, embracing a global mindset that's inclusive,
agile, mission-focused, and customer-focused.
- Give Recognition, participating in an environment where people
are rewarded for jobs well done.
- Embody an Entrepreneurial 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:
- Career advancement potential locally, nationally and
internationally. Crawford & Company has more than 700 locations in
- On-going training opportunities through every stage of your
- 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.
Keywords: Crawford & Company, San Francisco , Nurse - Senior Medical Case Manager (San Francisco CA), Executive , San Leandro, California
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