Medical Case Manager

About the role

We're seeking an RN with a passion for case management to join our team. The ideal candidate will have an RN degree, preferably a BSN, and at least 1-3 years of diverse clinical experience. National certification as a case manager (URAC-approved list) is preferred, but a registered nurse (RN) license is required. Applicants must also be compliant with state requirements regarding national certifications and possess a valid driver's license.

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).
• Provides opinions regarding case costs, treatment plans, outcomes, and problem areas, and makes recommendations to achieve case management goals.
• Maintains administrative requirements, including productivity, time management, and Quality Assurance (QA) standards, with minimal supervision.
• Performs job site evaluations/summaries to facilitate case management processes.
• Facilitates timely RTW by building professional relationships with the injured worker, employer, and physicians.
• Coordinates RTW with employers and claims adjusters, ensuring timely communication and authorization for services.
• Maintains contact with all parties involved in the case, necessary for RTW and case resolution.
• May obtain records from branch claims offices, review files for claims adjusters and supervisors, and meet with employers to review active files.
• Makes referrals for peer reviews and IMEs, providing medical records and diagnostic films, and communicating with physicians.
• Utilizes clinical expertise and medical resources to interpret medical records and test results, providing assessments accordingly.
• Spends approximately 70% of work time traveling to homes, health care providers, job sites, and various offices to facilitate RTW and resolve cases.
• Meets monthly production and QA requirements to ensure a quality product.
• Reviews cases with supervisors 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 approaching problem-solving with appropriate research and resource use.
• Performs other related duties as assigned.

Qualifications

• Associate's degree or relevant coursework/certification in Nursing is required; BSN is preferred.
• Minimum of 1-3 years diverse clinical experience and one of the following: URAC-approved case manager certification (preferred), RN license.
• 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 communications skills to 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.
• Demonstrated organizational skills as evidenced by proven ability to handle multiple tasks simultaneously.
• Demonstrated leadership ability with a basic understanding of supervisory and management principles.
• Travel may entail approximately 70% of work time.
• Maintain a valid driver's license in state of residence.

Benefits

We offer a competitive base pay, bonus/incentive pay, and other performance-based rewards. Our benefits package includes:

• Medical, Dental, and Vision Plans
• Paid holidays, vacation, and sick leave
• 401(k) Retirement Plan
• Tuition Assistance
• Paid parental leave
• Sustainability programs
• Caregiving Services
• Life Assistance Program
• Enhanced mental health support
• Virtual physical therapy
• Other benefits currently available at no cost

Learn more about what it's like to work at Crawford and our commitment to diversity, equity, and inclusion.