Medical Case Manager

Remote position with local field travel in the Portland, OR 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. Our team is empowered to grow, emboldened to act, and inspired to innovate, pioneering new solutions for the industries and customers we serve. With a presence in over 70 countries and speaking 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 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 and 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 plans, outcomes, 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, direction, or secure authorization for services.
• 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, 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 and quality assessment (QA) requirements.
• 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.

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 facilitate return-to-work solutions and ensure timely, quality documentation.
• Excellent analytical and customer service skills to resolve 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, or 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 a defined pay range based on experience, education, market rates, and other factors.
• Quarterly bonus opportunities and other performance-based rewards.
• 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 at no cost.
• Training programs promoting continuous learning and career progression.
• Sustainability programs supporting community engagement.
• Culture of respect, collaboration, entrepreneurial spirit, and inclusion.