SyracuseRecruiter Since 2001
the smart solution for Syracuse jobs

Nurse - Medical Case Manager

Company: Crawford & Company
Location: Syracuse
Posted on: March 26, 2020

Job Description:

Excellence In Everything We TouchPosition SummaryThis is a work from home position requiring 70% local field case management travel in the Albany, Poughkeepsie, Syracuse, and surrounding areas.RN licensure required; WC Case management experience highly preferred.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 individuals 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 management process. 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 worker/disabled individual. 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 IMEs 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 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 obtain directions. Upholds the Crawford and Company Code of Business Conduct at all 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 perform other related duties as assigned.Requirements Associates degree or relevant course work/certification in Nursing is required. Minimum of 3-5 years diverse clinical experience and one of the below Certification as a case manager from the URAC-approved list of certifications; A bachelors (or higher) degree in a health or human services related field; A registered nurse (RN) license. Valid RN licensure in the state(s) the incumbent works in. 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 organization. Travel may entail approximately 70% of work time. Must maintain a valid drivers license in state of residence. 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.Preferred: 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 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 thats 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 www.crawfordandcompany.com.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.#LI-SM1by Jobble

Keywords: Crawford & Company, Syracuse , Nurse - Medical Case Manager, Executive , Syracuse, New York

Click here to apply!

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

I'm looking for
in category
within


Other Executive Jobs


Nurse Manager
Description: Nurse ManagerGeneral Job DescriptionPromotes and restores patients' health by developing day-to-day management and long- term planning of patient care in a trauma informed care setting providing substance (more...)
Company: Psychiatric and Substance Abuse Services
Location: Syracuse
Posted on: 03/31/2020

Director, Quality Improvement
Description: Job DescriptionJob Summary: br br Molina's Quality Improvement function oversees, plans, and implements new and existing healthcare quality improvement initiatives and education programs ensures (more...)
Company: Molina Healthcare
Location: Syracuse
Posted on: 03/29/2020

Account Manager (Pharmaceutical Sales Development Program)
Description: OTSUKA - PEOPLE CREATING NEW PRODUCTS FOR BETTER HEALTH WORLDWIDEWe are looking for talented individuals to join our ReadyNow Sales Development Program If you love a fast-paced, ever-changing,
Company: Otsuka
Location: Rochester
Posted on: 03/29/2020


Commercial Lines Assistant Account Manager
Description: General Description: Assist Sales Executive and Account Manager in servicing and retention of Commercial clients. Works to ensure client retention goals are met by responding promptly to requests from (more...)
Company: USI Insurance Services
Location: Rochester
Posted on: 03/29/2020

Director, Thoracic Oncology
Description: Call for Candidates, Nominations and Referrals Director, Thoracic Medical Oncology - Associate/Full Professor Medical Oncologist c/o Tyler Company The Organization: The University of Rochester's Division (more...)
Company: University of Rochester/Wilmot Cancer Institute
Location: Rochester
Posted on: 03/29/2020

Account Manager
Description: Account Manager br br Who We Are br br Veritone One is a full-service agency creating native and traditional advertising for some of the world's most recognizable brands. Our expertise in media (more...)
Company: Veritone
Location: Binghamton
Posted on: 04/1/2020

Sales Director - Business Owner
Description: Lifestyle Publications was founded in 2009, and for multiple years, they have been recognized by INC Magazine as one of the top 5,000 fastest growing private companies in the United States.-- Due to (more...)
Company: Lifestyle Publications
Location: Rochester
Posted on: 03/29/2020

Assistant Branch Manager
Description: br br br Assistant Branch Manager br br br 954890 br br br br Job Type br br Full-time br br br br Category br br br Location br br Utica, NY 50 Auert St (more...)
Company: Berkshire Hills Bancorp
Location: Utica
Posted on: 03/31/2020

Lead Manager-Security Architecture & Engineering
Description: Experience the future of job applications Click to complete a quick chat with our AI recruiter, Wendy, and tell her about your qualifications. Reporting to the Chief Information Security Officer CISO (more...)
Company: Equitable
Location: Syracuse
Posted on: 03/31/2020

Family Medicine Residency Program Director-Rochester Regional Health
Description: Rochester Regional Health ---has initiated a nationwide search for a--- Family Medicine Residency Program Director ---at United Memorial Medical Center in--- Batavia, NY . United Memorial---s Family Medicine (more...)
Company: Rochester Regional Health
Location: Rochester
Posted on: 03/29/2020

Log In or Create An Account

Get the latest New York jobs by following @recnetNY on Twitter!

Syracuse RSS job feeds