Nurse - Medical Case Manager
Posted on: January 6, 2020
Excellence In Everything We Touch
Position SummaryThis is a work from home position requiring local
field case management travel to cover the Middle TN region. RN
required, prior Case Management, Workers Compensation Experience a
plus. National Certification a plus.
To provide effective 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 Assurance (QA) 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
- Reviews case records and reports, collects and analyzes data,
evaluates injured worker/disabled individual's medical status,
identifies needs and obstacles to medical case resolution and RTW
by providing proactive case management services.
- Render opinions regarding case costs, treatment plan, outcome
and problem areas, and makes recommendations to facilitate case
management goals to include RTW.
- Demonstrates ability to meet administrative requirements,
including productivity, time management and QA standards, with a
minimum of supervisory intervention.
- May perform job site evaluations/summaries to facilitate case
- Facilitate timely return to work date by establishing a
professional working relationship with the injured worker/disabled
individual, physician, and employer. Coordinate RTW with injured
worker, employer and physicians.
- Maintains contact and communicates with claims adjusters to
apprise them of case activity, case direction or secure
authorization for services. Maintains contact with all parties
involved on case, necessary for case management the injured
- May obtain records from the branch claims office.
- May review files for claims adjusters and supervisors for
appropriate referral for case management services.
- May meet with employers to review active files.
- Makes referrals for Peer reviews and IME's by obtaining and
delivering medical records and diagnostic films, notifying injured
worker/disabled individual and conferring with physicians.
- Utilizes clinical expertise and medical resources to interpret
medical records and test results and provides assessment
- May spend approximately 70% of their work time traveling to
homes, health care providers, job sites and various offices as
required facilitating RTW and resolution of cases.
- Meets monthly production requirements and quality assessment
(QA) requirements to ensure a quality product.
- Reviews cases with supervisor monthly to evaluate files and
- Upholds the Crawford and Company Code of Business Conduct at
- Demonstrates excellent customer service, and respect for
customers, co-workers, and management.
- Independently approaches problem solving by appropriate use of
research and resources.
- May perform other related duties as assigned.
- Associate's degree or relevant course work/certification in
Nursing is required.
- Minimum of 3-5 years diverse clinical experience and one of the
- Certification as a case manager from the URAC-approved list of
- A bachelors (or higher) degree in a health or human services
- A registered nurse (RN) license.
- Valid RN licensure in the state(s) the incumbent works
- Must meet specific licensing requirements to provide medical
case management services.
- Minimum of 1 National Certification (CCM, CDMS, CRRN, and COHN)
is highly preferred. If not attained, must plan to take
certification exam within proceeding 24 months and have a minimum
of 4 years WC case management experience/demonstrated excellent
performance in a similar position with another
- Travel may entail approximately 70% of work time.
- Must maintain a valid driver's license in state of
- General working knowledge of case management practices and
ability to quickly learn and apply workers compensation/case
management products and services.
- Excellent oral and written communications skills to effectively
facilitate return-to-work solutions within a matrix organization
and ensure timely, quality documentation.
- Excellent analytical and customer service skills to facilitate
the resolution of case management problems.
- Basic computer skills including working knowledge of Microsoft
Office products and Lotus Notes.
- Demonstrated ability to establish collaborative working
relationships with claims adjusters, employers, patients, attorneys
and all levels of employees.
- BSN Degree is preferred.
About UsThink 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
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
- 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: Broadspire, Hendersonville , Nurse - Medical Case Manager, Executive , Hendersonville, Tennessee
Didn't find what you're looking for? Search again!