Medical Case Manager

Remote position with local field travel in the Columbia, SC region.

About Us

At Crawford, we believe a claim is more than a number—it’s a person, a child, a friend. We help restore lives and communities, one claim at a time. Our team is empowered to grow, act, and innovate, pioneering solutions for the industries and customers we serve. With a presence in over 70 countries and dozens of languages, we operate as One Crawford: united in purpose, vision, and values.

About the Role

We’re looking for a Registered Nurse (RN) with a passion for case management to join our team. In this role, you’ll provide effective, cost-efficient case management services aligned with URAC standards, CMSA Standards of Practice, and Broadspire QA Guidelines. You’ll support patients and employees receiving benefits under Workers’ Compensation, Group Health, Liability, Disability, and Care Management programs. This is an opportunity to grow your career, earn rewards, and achieve work-life balance.

Responsibilities

• Review case records and reports, collect and analyze data, and evaluate the medical status of injured workers or disabled individuals to identify needs and obstacles to medical case resolution and return-to-work (RTW).
• Provide proactive case management services, render opinions on case costs, treatment plans, outcomes, 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 RTW by establishing professional relationships with injured workers, physicians, and employers, and coordinate RTW efforts among all parties.
• Maintain contact and communicate with claims adjusters to update them on case activity, direction, or secure authorization for services.
• Maintain communication with all involved parties to ensure effective case management for the injured worker or disabled individual.
• Obtain records from branch claims offices as needed.
• Review files for claims adjusters and supervisors to determine appropriate referrals 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, notifying the injured worker, 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 case resolution.
• Meet monthly production and quality assessment (QA) requirements to ensure a high-quality product.
• Review cases with supervisor monthly to evaluate files and obtain direction.
• 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 using research and resources.
• Perform other related duties as assigned.

Qualifications

• 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 and case management products and services.
• Excellent oral and written communication skills to facilitate RTW solutions within a matrix organization and ensure timely, quality documentation.
• Strong analytical and customer service skills to resolve case management problems.
• Basic computer skills, including proficiency with Microsoft Office products and Lotus Notes.
• Demonstrated ability to establish collaborative working relationships with claims adjusters, employers, patients, attorneys, and employees at all levels.
• Proven ability to gather and analyze data, and establish plans to improve trends, processes, and outcomes.
• Excellent organizational skills, with the 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 (e.g., CCM, CDMS, CRRN, COHN) is preferred. If not attained, must plan to take the certification exam within 36 months.
• National certification is required to reach Senior Medical Case Management status.
• Travel may entail approximately 70% of work time.
• Must maintain a valid driver’s license in the 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 (e.g., enhanced mental health support, virtual physical therapy, caregiving services, life assistance program).
• Training programs to promote continuous learning and career progression.
• Sustainability programs that support the communities where we live and work.
• A culture of respect, collaboration, entrepreneurial spirit, and inclusion.