Sr Vocational Case Manager-CA

Crawford•Fresno, CA

About The Position

Responsibilities May assist supervisor/manager in review of reports, staff development. 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. Performs various duties including vocational evaluation, counseling, medical assessment and coordinate return to work. Demonstrates ability to meet or surpass administrative requirements, including productivity, time management, quality assessment (QA) standards with a minimum of supervisory intervention. Facilitates a timely return to work date by establishing a professional working relationship with the client, physician and employer. Coordinates return to work with patient, employer and physicians. May recommend and facilitate completion of peer reviews and independent medical exams (IME's) by obtaining and delivering medical records and diagnostic films notifying patients. Manages cases of various product lines of at least 3-4 areas of service (W/C, Health, STD, LTD, Auto, Liability, TPA, Catastrophic, Life Care Planning). Specifically, the case manager should be experienced in catastrophic cases plus 2-3 additional types listed above. Renders opinions regarding case costs, treatment plan, outcome and problem areas and makes recommendations to facilitate rehabilitation goals and RTW. May review files for claims adjusters and supervisors. May perform job site evaluations/summaries. Prepares monthly written evaluation reports denoting case activity, progress and recommendations in accordance with state regulations and Broadspire' standards. May obtain referrals from branch claims office or assist in fielding phone calls for management as needed. 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 rehabilitation of the client. Travels to homes, health care providers, job sites, and various offices as required to facilitate return to work and resolution of cases. May meet with employers to review active files. Reviews cases with supervisor monthly to evaluate file and obtain direction. Upholds the Crawford Code of Business Conduct at all times. Demonstrates excellent customer service, and respect for customers, co-workers, and management Independently approaches problem resolution by appropriate use of research and resources. May perform other related duties as assigned.

Requirements

Bachelor's degree in Rehabilitation counseling/professional credentialing is required.
Minimum of five (5) years industry experience and at least one year of experience with Broadspire.
Demonstrated ability to handle complex assignments and ability to work independently is required.
Effective oral and written communication skills are required.
Based on federal, state, or local law, this position may require you to be fully vaccinated for COVID-19.
Must hold industry certification (CVE, CIRS, CCM, and CRC).
Minimum of 1 nationally recognized Certification from the URAC list of approved certifications.
Must maintain a valid driver's license in state of residence.
Travel entails 70% of work time.

Nice To Haves

Masters degree is preferred.
Job performance above Broadspire standard is preferred.

Responsibilities

May assist supervisor/manager in review of reports, staff development.
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.
Performs various duties including vocational evaluation, counseling, medical assessment and coordinate return to work.
Demonstrates ability to meet or surpass administrative requirements, including productivity, time management, quality assessment (QA) standards with a minimum of supervisory intervention.
Facilitates a timely return to work date by establishing a professional working relationship with the client, physician and employer.
Coordinates return to work with patient, employer and physicians.
May recommend and facilitate completion of peer reviews and independent medical exams (IME's) by obtaining and delivering medical records and diagnostic films notifying patients.
Manages cases of various product lines of at least 3-4 areas of service (W/C, Health, STD, LTD, Auto, Liability, TPA, Catastrophic, Life Care Planning).
Specifically, the case manager should be experienced in catastrophic cases plus 2-3 additional types listed above.
Renders opinions regarding case costs, treatment plan, outcome and problem areas and makes recommendations to facilitate rehabilitation goals and RTW.
May review files for claims adjusters and supervisors.
May perform job site evaluations/summaries.
Prepares monthly written evaluation reports denoting case activity, progress and recommendations in accordance with state regulations and Broadspire' standards.
May obtain referrals from branch claims office or assist in fielding phone calls for management as needed.
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 rehabilitation of the client.
Travels to homes, health care providers, job sites, and various offices as required to facilitate return to work and resolution of cases.
May meet with employers to review active files.
Reviews cases with supervisor monthly to evaluate file and obtain direction.
Upholds the Crawford Code of Business Conduct at all times.
Demonstrates excellent customer service, and respect for customers, co-workers, and management Independently approaches problem resolution by appropriate use of research and resources.
May perform other related duties as assigned.