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Based in Atlanta, Georgia, Crawford & Company () 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 SolutionsSM 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 a seasonal onsite 40 hour per week position ending December 31, 2009 Summary of Role:
Provide resolution of complex Workers' Compensation claims. Resolution may include return to work activities, facilitating medical care with providers and the Employer's health care plans, and achieving directed case management strategy outcomes. Claim resolution may involve working directly with the Employer, Attorneys, Investigators, Rehabilitation Counselors, the employee, the treatment provider and other professionals assigned to the claim. This job has no supervisory responsibilities. Responsibilities: - Develops appropriate treatment plans that ensure a balance between quality of care and cost effectiveness.
- Clinically evaluates the recovery needs of an injured employee by a thorough interview of the employee, employer and providers.
- Identifies barriers to recovery and formulates an action plan to overcome these barriers. Assesses health records and medical reports.
Manages injured workers file and adheres to treatment guidelines and utilization criteria as determined by state mandated guidelines, proprietary and nationally published protocols, as well as customer requirements.
Addresses return to work capability with the injured worker and provider at each visit and evaluation. Calculates and monitors the estimated length of disability according to published criteria such as Presley Reed, relaying this information to the client.
Formulates and implements treatment plans, engages the patient in plan development, and educates the patient in procedural process to optimize the potential outcome of treatment.
Uses system to manage and maintain case files.
Facilitates and coordinates provider, facility, and durable medical equipment referrals to expedite case activity, thereby advancing the patient toward medical stability and avoidance of barriers.
Negotiates services and equipment to obtain quality, cost effective outcomes.
Provides guidance to Case Reviewers as needed.
Act as a liaison to adjusters.
Performs other related projects and duties as assigned.
Education: - Minimum LPN state licensure required,
- RN state licensure in good standing with the State Board of Nursing strongly preferred.
- Bi-Lingual Spanish a plus
Experience: - Previous Case Management Experience preferred.
Knowledge and Skills: - Expertise in analytical problem solving, decision making with sound judgment,
- Good organizational and time management skills, and excellent verbal and written communication skills.
- Must type 30 words per minute.
- Must posses a working knowledge of computers with the ability to use standard word processing, excel, and software applications.
- Effectively utilizes desktop tools to conform with State jurisdictional guidelines and account specific criteria.
- Exhibits a proven knowledge of multiple product lines and Services.
- Subject matter expert on Broadspire's medical management services.
- Demonstrates a proficiency in State Jurisdictional Guidelines and Account Specific criteria as applicable.
Crawford offers excellent benefits, training and competitive salaries. If you are interested in joining a leader in the claims management industry, please apply now. EOE M/F/D/V.
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