Medical Case Manager

About the role

We're seeking an RN with a passion for case management to join our team. The ideal candidate should have an RN degree, preferably a BSN, and one of the following certifications: CCM, CRC, COHN, CRRC. Experience in Workers' Comp Case Management is a plus.

Responsibilities

• Reviews case records and reports, collects and analyzes data, evaluates medical status, and identifies needs and obstacles to medical case resolution and Return to Work (RTW).
• Makes recommendations to facilitate case management goals, including RTW.
• Demonstrates ability to meet administrative requirements, including productivity, time management, and Quality Assurance (QA) standards.
• Performs job site evaluations/summaries to facilitate case management process.
• Facilitates timely RTW by establishing a professional working relationship with the injured worker, employer, and physician.
• Coordinates 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 the case, necessary for RTW and case management.
• Makes referrals for peer reviews and IMEs by obtaining and delivering medical records and diagnostic films, notifying the 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.
• Spend approximately 70% of work time traveling to homes, health care providers, job sites, and various offices as required to facilitate RTW and resolve cases.
• Maintains monthly production and 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, respect for customers, co-workers, and management.
• Independently approaches problem-solving by using appropriate research and resources.

Qualifications

• Associate's degree or relevant course work/certification in Nursing is required; BSN Degree is preferred.
• Minimum of 1-3 years diverse clinical experience.
• One of the following certifications: CCM, CDMS, CRRN, COHN, preferred.
• Active RN home state licensure in good standing without restrictions with the State Board of Nursing.
• Minimum of 1 National Certification (CCM, CDMS, CRRN, COHN) is preferred. If not attained, must plan to take certification exam within proceeding 36 months.
• National certification must be obtained in order to reach Senior Medical Case Management status.
• Travel may entail approximately 70% of work time.
• Maintain a valid driver's license in state of residence.

Benefits

We offer a competitive salary, quarterly bonus opportunities, free CEUs for licenses and certificates, and license and certification reimbursement. Our benefits package includes:

• Medical, Dental, and Vision Plans
• Paid holidays, vacation, and sick leave
• 401(k) Retirement Plan
• Tuition Assistance
• Supplemental Health Benefits
• Enhanced Mental Health Support
• Virtual Physical Therapy
• Caregiving Services
• Life Assistance Program

Learn more about our company culture and values at www.crawco.com.