Sr Medical Case Manager

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 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. This role involves providing effective case management services in a cost-effective manner, adhering to 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. This position offers a hybrid work arrangement with local field travel in the Lubbock, TX region.

Responsibilities

• Review case records and reports, collect and analyze data, evaluate client's medical and vocational status, and define needs to provide proactive case management services.
• Demonstrate ability to meet or surpass administrative requirements, including productivity, time management, and quality assessment (QA) standards with minimal supervisory intervention.
• Facilitate a timely return-to-work date by establishing professional relationships with injured workers, physicians, and employers; coordinate return-to-work plans.
• Recommend and facilitate completion of peer reviews and Independent Medical Examinations (IMEs) by obtaining and delivering medical records and diagnostic films.
• Manage cases across various product lines, including Workers’ Compensation, Group Health, Short-Term Disability (STD), Long-Term Disability (LTD), Auto, Liability, Third-Party Administration (TPA), Catastrophic cases, and Life Care Planning. Experience in catastrophic cases plus 2-3 additional types is required.
• Render opinions on case cost, treatment plans, outcomes, and problem areas; make recommendations to facilitate rehabilitation and return-to-work goals.
• Review files for claims adjusters and supervisors as needed.
• Perform job site evaluations and prepare monthly written evaluation reports detailing case activity, progress, and recommendations in accordance with state regulations and company standards.
• Maintain contact and communicate with insurance adjusters to update them on case activity and receive authorization for services.
• Maintain communication with all parties involved in the case to facilitate client rehabilitation.
• Travel approximately 70% of work time to homes, healthcare providers, job sites, and various offices to facilitate return-to-work and case resolution.
• Meet with employers to review active files and provide updates.
• Review cases with supervisor monthly to evaluate progress 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 resolution using research and resources.
• Perform other related duties as assigned.

Requirements

• Active RN home state licensure in good standing without restrictions with the State Board of Nursing.
• Minimum of 1 nationally recognized certification from the URAC list of approved certifications (e.g., CCM, CRC, COHN, CRRN).
• Three years of Workers’ Compensation case management experience with the ability to independently coordinate a diverse caseload ranging from moderate to high complexity.
• Demonstrated ability to handle complex assignments and work independently.
• Effective oral and written communication skills.
• Thorough understanding of jurisdictional Workers’ Compensation statutes.
• Advanced knowledge to positively influence all areas of case management.
• Advanced communication and interpersonal skills to conduct training, provide mentorship, and assist supervisors as needed.
• Highly skilled at promoting managed care products and services internally and externally.
• Must maintain a valid driver’s license in state of residence and be able to travel as required.

Qualifications

• Bachelor’s Degree in a health-related field preferred; Associate’s degree or diploma in nursing accepted.
• Individuals conducting initial clinical reviews must possess an active, professional license or certification to practice as a health professional in a U.S. state or territory, with a scope relevant to the clinical area addressed.

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 promoting continuous learning and career progression.
• Sustainability programs that give back to communities.
• Culture of respect, collaboration, entrepreneurial spirit, and inclusion.