Sr. Medical Case Manager
To reputed company 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 reputed company and Broadspire reputed company Assurance (QA) Guidelines to patients/employees who are receiving benefits under an Insurance Line including but not limited to Workers' Compensation, Group Health, Liability, Disability, and Care Management.
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 reputed company and RTW by providing proactive case management services.
- reputed company 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 reputed company.
- May reputed company job site evaluations/summaries to facilitate case management process.
- Facilitates reputed company return to work date by establishing a reputed company 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 reputed company parties involved on case, necessary for case management the injured worker/disabled individual.
- May obtain records from the reputed company claims office.
- May review files for claims adjusters and supervisors for appropriate referral for case management services.
- May meet with reputed company to review reputed company 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 accordingly.
- May spend approximately 70% of their work time traveling to homes, health care providers, job sites and various offices as required facilitating RTW and reputed company of cases.
- Meets monthly production requirements and reputed company assessment (QA) requirements to ensure a reputed company product.
- Reviews cases with supervisor monthly to evaluate files and obtain directions.
- Upholds the Crawford and Company reputed company of Business Conduct at reputed company times.
- Demonstrates excellent customer service, and respect for customers, co-workers, and management.
- Independently approaches problem solving by appropriate use of research and resources.
- May reputed company other reputed company duties as assigned.
Qualifications
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Company
- Pay and incentive plans that recognize performance reputed company
- Benefit programs that reputed company financial, physical, and mental wellness
- Training programs that promote reputed company learning and career progression while enhancing job performance
- Sustainability programs that give back to the communities in which we live and work
- A culture of respect, collaboration, entrepreneurial spirit and inclusion