Medical Case Manager

Work from home with local field travel in the Indianapolis, IN region.

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 are helping to restore our community—one claim at a time. Employees are empowered to grow, emboldened to act, and inspired to innovate. Our industry-leading team pioneers new solutions for the industries and customers we serve. We operate as One Crawford: united in purpose, vision, and values, with a global presence spanning over 70 countries and dozens of languages.

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 provide proactive case management services.
• Render opinions regarding case costs, treatment plan, outcome, and problem areas; make recommendations to facilitate case management goals, including return-to-work (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 relationships with the injured worker/disabled individual, physician, and employer; coordinate RTW with all parties.
• 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 for the injured worker/disabled individual.
• Obtain records from the branch claims office as needed.
• Review files for claims adjusters and supervisors to determine 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; provide 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 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 by using research and resources appropriately.
• 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.
• One of the following:
  • Certification as a case manager from the URAC-approved list of certifications (preferred);
  • Active RN license.
• Compliance 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, with 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.
• 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.
• Additional benefits at no cost, including:
  • 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.
• A culture of respect, collaboration, entrepreneurial spirit, and inclusion.