Nurse Case Manager- Part Time

3 days left

Employer
Crawford & Company
Location
Pensacola, Florida
Salary
Not Specified
Posted
Feb 07, 2019
Closes
Mar 23, 2019
Ref
6358031#GIJtoGJS.5
Industry
Insurance
Category
Insurance
Excellence In Everything We Touch

Broadspire Med Management

Position Summary

This is a Part Time Work From Home position requiring local field case management travel and a National Certification.

Our ideal candidate must reside in the Florida Panhandle region.

The Nurse Case Manager will review all claims once established in the claim system. The Nurse Case Manager will provide direction, education and guidance relative to clinical and vocational components of each claim. In addition, the Nurse Case Manager will oversee or perform medical case management and coordination of services provided to ill or injured staff members of the World Bank Group (WBG) and adhere to the Staff Rules which guide the disability and workers compensation program.

Responsibilities

  • Reviews, analyzes and makes recommendations based on medical documents
  • Contacts medical providers to verify clinical information, identify factors that may influence the length of disability, and discuss options to return to work as appropriate
  • Consults with treating physician(s)and employer representative(s) to negotiate the return of staff members to employment
  • Assess medical information and makes disability determinations based on the staff members functional capacity in comparison to the functional requirements of his/her job
  • May confer with WBG to evaluate the work environment and to determine the possibility of the staff members return to their former position
  • Identifies safety concerns within the home environment to ascertain possible barriers to rehabilitation process via conversations with the staff member.
  • Notifies referral sources when injured workers condition is not feasible for return to work.
  • Recommends and monitors job site modifications to accommodate the staff members residual physical abilities, if required.
  • Makes recommendations for IMEs as appropriate
  • Coordinates as needed with WBGs Health Services Department (HSD) for all items regarding clinical case management and workplace accommodation.
  • Coordination of clinical field staff (nurses and vocational specialists) for on-site non-occupational and occupational claims assessment and management as needed.
  • Coordinates IMEs and/or Physician Reviews as appropriate
  • Maintains adherence to all WBGs special handling instructions, pertinent laws, advocacy, ethical, safety, regulations, and confidentiality standards.
  • Upholds the Crawford Code of Business Conduct at all times
  • Utilizes evidenced based medicine when performing claim reviews
  • Acts as a medical management resource for claim examiners, case managers and WBG
  • Identify, formulate, and implement training / educational programs as needed to support the quality of the WBGs disability program
  • Upholds the Crawford Code of Conduct

Requirements

  • RN state licensure in good standing with the State Board of Nursing
  • Minimum of two years Case Management experience.
  • Minimum eight years of clinical expertise preferably in a varied clinical environment.
  • Advanced certification in case management or other clinically relevant area (i.e. CCM, CRRN, ABQUAR, CPHQ, COHN, or QRP) is required.
  • Maintain state licenses as requested.
  • Must be able to travel as required.
  • Expertise in analytical problem solving,
  • Decision making with sound judgment, good organizational and time management skills, and excellent verbal and written communication skills.
  • Fluent speaking, writing and reading in a second language preferably, French, Spanish, or German.
  • Must type 30 words per minute.
  • Must possess a working knowledge of computers with the ability to use standard word processing, excel, and software applications.
  • Effectively utilizes desktop tools to conform to State jurisdictional guidelines and account specific criteria.
  • Exhibits a proven knowledge of multiple product lines and services.
  • Subject matter expert on Broadspires medical management services. Demonstrates a proficiency in State Jurisdictional Guidelines and Account Specific criteria as applicable.

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 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.

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