Responsible for providing proactive case management services by assessing existing medical records.

A. Case Management Services

• Analyzes and reviews case records, evaluates client’s medical status, and defines their needs and problems
• Provides opinions regarding case costs, treatment plan, outcome and problem areas, and makes recommendation to facilitate rehabilitation goals and return to work
• Utilizes experience and medical resources to interpret medical records and test results, and provide appropriate assessments accordingly
• Reviews cases with immediate superior monthly to evaluate files and obtain directions
• Performs job site evaluations/summaries to facilitate case management process

B. Client Relations

• Establishes professional working relationship with internal and external clients by timely return to work
• Maintains contact with all parties involved on case to appraise them of case activity, case direction, or receive authorization for services

C. Business Process Support

• Performs peer reviews and independent medical examination
• Meets monthly production and quality assessment (QA) requirements
• Deals with problem resolution independently by using appropriate research and resources
• Refers matters beyond limits of authority and expertise to immediate superior for direction
• Upholds the Crawford Code of Conduct by protecting the confidentiality of information
• Performs other related tasks as required or needed

• Minimum of two (2) years diverse clinical experience or prior experience in Medical Bill Review.
• Bachelor’s degree in Nursing.
• Must be a Philippine Registered Nurse; has an active US Registered Nurse license from New York if required by the process.
• Excellent verbal communication skills and customer orientation
• Proficient in word processing software applications
• Analytical skills - Ability to perform basic and complex bill review according to standard operating procedures (SOP)
• Ability to deliver excellent customer service
• Active listening and phone handling skills
• Critical thinking skills - Ability to make judgements and recommendations
• Maintains high degree of professionalism and confidentiality
• Ability to multi-task, prioritize and manage time effectively
• Interpersonal skills - Able to work independently and as a team member
• Keen attention to details