SanFranRecruiter Since 2001
the smart solution for San Francisco jobs

Nurse - Senior Medical Case Manager (San Francisco CA)

Company: Crawford & Company
Location: San Leandro
Posted on: November 11, 2019

Job Description:

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 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 client, physician and employer. Coordinates return to work with patient, 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 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 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.
  • 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.
  • Upholds the Crawford Code of Business Conduct at all times.
  • 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 residence.
      • Demonstrated ability to handle complex assignments and ability to work independently is required.
      • Effective oral and written communication skills are 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.
      • 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, we:
        • 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 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.

Keywords: Crawford & Company, San Francisco , Nurse - Senior Medical Case Manager (San Francisco CA), Executive , San Leandro, California

Click here to apply!

Didn't find what you're looking for? Search again!

I'm looking for
in category

Other Executive Jobs

RN/Director of Women's Services (511113) $20,000 sign on bonus
Description: JOB CODE: 511113 RN/Director of Women's Services LOCATION: San Joaquin County CA Enjoy up to a 20,000 sign on bonus with this great opportunity to join a health care system renowned as an innovative (more...)
Company: Veritas Global Consulting Group, LLC
Location: Manteca
Posted on: 11/23/2019

Loss Control Director
Description: Loss Control Manager Monterey Educational Risk Management Authority MERMA - Salinas, CA The Monterey Educational Risk Management Authority MERMA is a California Joint Powers Authority JPA providing (more...)
Company: Monterey Educational Risk Management Authority (ME
Location: Salinas
Posted on: 11/23/2019

Branch Operations Manager
Description: At Beneficial State bank, we are looking for a believer and supporter of enriching our local communities with us through our triple bottom line approach toward social justice, environmental resilience, (more...)
Company: Beneficial State Bank
Location: Santa Rosa
Posted on: 11/23/2019

Travel Nurse RN - Case Management - $2,800 per week
Description: NurseFly Travel Nursing with Skyline Med Staff Nursing is seeking a case management travel nurse for a travel nursing job in Sunnyvale, California: br br br ul br li Specialty: Case Management (more...)
Company: NurseFly Travel Nursing
Location: Sunnyvale
Posted on: 11/23/2019

Women's Services Director
Description: This role provides leadership and support to the senior executive position CNO responsible for all nursing and other designated patient care functions/services within the hospital organization. The (more...)
Company: Jericho HR Group
Location: Manteca
Posted on: 11/23/2019

Unit Manager - RN
Description: Description br br HCR ManorCare provides a range of services, including skilled nursing care, assisted living, post-acute medical and rehabilitation care, hospice care, home health care and rehabilitation (more...)
Company: HCR Manorcare Inc.
Location: Sunnyvale
Posted on: 11/23/2019

Description: An exciting opportunity awaits an experienced Chief Financial Officer to work for a rural not for profit hospital in Central
Location: Salinas
Posted on: 11/23/2019

Sr. Manager, Technical Program Manager
Description: SUMMARY: In this technical lead role, you will be working closely with customers and manufacturing to support new products from feasibility/design phase through process development and qualification to (more...)
Company: ASE Group Global
Location: Sunnyvale
Posted on: 11/23/2019

Salesforce Project Manager
Description: Ref ID: 00420-9502289896Classification:
Company: Robert Half Technology
Location: Sunnyvale
Posted on: 11/23/2019

Team Manager - Distribution Center
Description: McCormick Company, Inc., a world leader in the spice, flavor and seasonings industry, is seeking a full time Team Manager . This new hire will work in our Salinas Plant, located at 341 El Camino Real (more...)
Company: McCormick & Company
Location: Salinas
Posted on: 11/23/2019

Log In or Create An Account

Get the latest California jobs by following @recnetCA on Twitter!

San Francisco RSS job feeds