Experience Inc. Jobs

Medical Case Manager - Part Time Requisition ID 2024-25961 Job Locations US-OH-Cleveland Position Type Seasonal Category Medical Case Management Business Unit BUS_TPA US Excellence In Everything We Touch Position Summary * Great Work Life Balance! * Monthly Bonus Program! * Free CEU's for licenses and certificates * License and national certification reimbursement This is a part-time work from home position requiring local field case management travel to cover the Cleveland, Ohio region. National Certification such as CCM, CRC, COHN, CRRC preferred. RN degree required. Prior Workers Compensation Case Management 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, Disability, and Care Management. Based on federal, state, or local law, this position may require you to be fully vaccinated for COVID-19. If required, the hiring manager will discuss with you during your interview process. 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 management process. * Facilitates 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 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 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 * Associate's degree or