Based in Atlanta, Georgia, Crawford & Company (www.crawfordandcompany.com) is the world's largest independent provider of claims management solutions to the risk management and insurance industry as well as self-insured entities, with a global network of more than 700 locations in 63 countries. The Crawford System of Claims Solutions^SM offers comprehensive, integrated claims services, business process outsourcing and consulting services for major product lines including property and casualty claims management, workers' compensation claims and medical management, and legal settlement administration. The Company's shares are traded on the NYSE under the symbols CRDA and CRDB.

This is a 'work from home' position with some local day travel involved.

Position is up to 20 hours per week with potential for full-time.

Summary of Role:

To facilitate quality 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 Improvement (QI) 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 client's medical and vocational status and defines needs and problems in order to provide proactive case management services.
   
• Demonstrates ability to meet administrative requirements, including productivity, time management and QI standards, with a minimum of supervisory intervention.
   
• Renders opinions regarding case costs, treatment plan, outcome and problem areas, and makes recommendations to facilitate rehabilitation goals and return to work.
   
• Performs job site evaluations/summaries; prepares monthly written evaluative reports, denoting case activity, progress and recommendations in accordance with state regulations and standards. 
   
• Facilitates timely return to work date by establishing a professional working relationship with the client, physician, and employer. Coordinate return to work with patient, employer and physicians.
   
• May recommend and facilitate completion of peer reviews and IME's by obtaining and delivering medical records and diagnostic films as well as conferring with physicians both in person and on phone.
   
• May review files for claims adjusters and supervisors.
   
• Maintains contact and communicates with insurance adjusters to apprise them of case activity, case direction or receive authorization for services. Maintains contact with all parties involved on case, necessary for case management for the client.
   
• May obtain referrals from branch claims offices.
   
• Utilizing experience and medical resources interprets medical records and test results and provides assessment accordingly. Utilizes nursing process, case management standards of practice guidelines and Broadspire's Quality Improvement Guidelines in providing medical case management services.
   
• May meet with employers to review active files.
   
• Meets monthly production requirements and quality assessment (QA) requirements to ensure a quality product.
   
• Travels to homes, health care providers, and various offices as required facilitating return to work and resolution of cases. (Approximately 70% of an OSCM's position is spent in travel). 
   
• Reviews case with supervisor monthly to evaluate files and obtain directions.
   
• May perform other related duties as assigned.