Medical Case Manager

Remote position with local field travel in the Boca Raton, FL region.

About the role

We’re looking for an RN with a passion for case management to join our team. You’ll provide effective case management services in a cost-effective manner, delivering medical case management consistent with URAC standards, CMSA Standards of Practice, and Broadspire QA Guidelines. You’ll support patients/employees receiving benefits under insurance lines including Workers’ Compensation, Group Health, Liability, Disability, and Care Management.

Responsibilities

• Review case records and reports, collect and analyze data, evaluate injured worker/disabled individual's medical status, identify needs and obstacles to medical case resolution and return-to-work (RTW) by providing proactive case management services.
• Render opinions regarding case costs, treatment plan, outcome and problem areas, and make recommendations to facilitate case management goals including RTW.
• Demonstrate ability to meet administrative requirements, including productivity, time management and QA standards, with minimal supervisory intervention.
• Perform job site evaluations/summaries to facilitate the case management process.
• Facilitate timely return-to-work by establishing professional working relationships with the injured worker/disabled individual, physician, and employer. Coordinate RTW with injured worker, employer, and physicians.
• Maintain contact and communicate with claims adjusters to apprise them of case activity, case direction, or secure authorization for services. Maintain contact with all parties involved in case management.
• Obtain records from the branch claims office as needed.
• Review files for claims adjusters and supervisors for appropriate referral for case management services.
• Meet with employers to review active files.
• Make referrals for Peer reviews and Independent Medical Examinations (IMEs) by obtaining and delivering medical records and diagnostic films, notifying the injured worker/disabled individual, and conferring with physicians.
• Utilize clinical expertise and medical resources to interpret medical records and test results, providing assessments accordingly.
• Spend approximately 70% of work time traveling to homes, healthcare providers, job sites, and various offices to facilitate RTW and resolution of cases.
• Meet monthly production requirements and quality assessment (QA) requirements to ensure a quality product.
• Review cases with supervisor monthly to evaluate files and obtain directions.
• Uphold the Crawford and Company Code of Business Conduct at all times.
• Demonstrate excellent customer service and respect for customers, co-workers, and management.
• Independently approach problem-solving by appropriate use of research and resources.
• Perform other related duties as assigned.

Requirements

• Associate's degree or relevant coursework/certification in Nursing is required; BSN Degree is preferred.
• Minimum of 1-3 years of diverse clinical experience and one of the following:
  • Certification as a case manager from the URAC-approved list of certifications (preferred);
  • Active RN license.
• Must be compliant with state requirements regarding national certifications.
• General working knowledge of case management practices and ability to quickly learn and apply workers' compensation/case management products and services.
• Excellent oral and written communication skills to effectively facilitate return-to-work solutions within a matrix organization and ensure timely, quality documentation.
• Excellent analytical and customer service skills to facilitate the resolution of case management problems.
• Basic computer skills including working knowledge of Microsoft Office products and Lotus Notes.
• Demonstrated ability to establish collaborative working relationships with claims adjusters, employers, patients, attorneys, and all levels of employees.
• Demonstrated ability to gather and analyze data and establish plans to improve trends, processes, and outcomes.
• Excellent organizational skills as evidenced by proven ability to handle multiple tasks simultaneously.
• Demonstrated leadership ability with a basic understanding of supervisory and management principles.
• Active RN home state licensure in good standing without restrictions with the State Board of Nursing.
• Must meet specific requirements to provide medical case management services.
• Minimum of 1 National Certification (CCM, CDMS, CRRN, and COHN) is preferred. If not attained, must plan to take certification exam within 36 months.
• National certification must be obtained to reach Senior Medical Case Management status.
• Travel may entail approximately 70% of work time.
• Must maintain a valid driver's license in state of residence.

Benefits

• Competitive base pay with quarterly bonus opportunities.
• Free Continuing Education Units (CEUs) for licenses and certificates.
• License and certification reimbursement.
• Comprehensive benefits package including:
  • Medical, dental, and vision plans.
  • Prescription drug coverage.
  • HSA, HRA, and FSA accounts.
  • Paid holidays, vacation, and sick leave.
  • 401(k) retirement plan.
  • Tuition assistance.
  • Paid parental leave.
  • Supplemental health benefits.
  • Enhanced mental health support.
  • Virtual physical therapy.
  • Caregiving services.
  • Life assistance program.
• Training programs that promote continuous learning and career progression.
• Sustainability programs that give back to the community.

About Us

At Crawford, we believe a claim is more than a number—it’s a person, a child, a friend. By helping to restore their lives, we restore our community—one claim at a time. Our industry-leading team pioneers new solutions for the industries and customers we serve. We’re looking for the next generation of leaders to join us, with employees empowered to grow, emboldened to act, and inspired to innovate. We hail from more than 70 countries and speak dozens of languages, reflecting the global fabric of the audience we serve. Though our reach is vast, we proudly operate as One Crawford: united in purpose, vision, and values.