Sr Medical Case Manager-CA

We’re looking for an RN with a passion for case management to join our remote team in the Los Angeles, CA region. This role involves work from home with local field travel.

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, act, and innovate, pioneering new solutions for the industries and customers we serve. We operate globally but unite as One Crawford with a shared purpose, vision, and values.

About the 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/employees receiving benefits under insurance lines including Workers’ Compensation, Group Health, Liability, Disability, and Care Management.

Responsibilities

• Assist supervisor/manager in review of reports and staff development.
• 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.
• 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 the client, physician, and employer; coordinate return-to-work plans.
• Recommend and facilitate completion of peer reviews and IMEs by obtaining and delivering medical records and diagnostic films, notifying patients.
• Manage cases across at least 3-4 product lines (e.g., Workers’ Compensation, Health, STD, LTD, Auto, Liability, TPA, Catastrophic, Life Care Planning), with experience in catastrophic cases plus 2-3 additional types.
• Render opinions on case cost, treatment plans, outcomes, and problem areas; make recommendations to facilitate rehabilitation goals and return-to-work (RTW).
• Review files for claims adjusters and supervisors.
• Perform job site evaluations/summaries and prepare monthly written evaluation reports denoting case activity, progress, and recommendations in accordance with state regulations and company standards.
• Obtain referrals from branch claims offices or assist in fielding phone calls for management as needed.
• Maintain contact and communicate with insurance adjusters to apprise them of case activity, direction, or receive authorization for services.
• Maintain contact with all parties involved in case rehabilitation.
• Spend approximately 70% of work time traveling to homes, healthcare providers, job sites, and various offices to facilitate return-to-work and case resolution.
• Meet with employers to review active files.
• Review cases with supervisor monthly to evaluate files and obtain direction.
• Uphold the Crawford 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

• Bachelor's Degree in a health-related field preferred; Associates or diploma in nursing also accepted.
• 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 exert positive influence in all areas of case management.
• Advanced communication and interpersonal skills to conduct training, provide mentorship, and assist supervisors.
• Highly skilled at promoting managed care products and services internally and externally.
• 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; preferred).
• Ability to travel as required, including approximately 70% local field travel.
• Active, unrestricted professional license or certification to practice as a health professional in a U.S. state or territory, with a scope relevant to clinical reviews.
• 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.
• 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.
• License and certification reimbursement.
• Free continuing education units (CEUs) for licenses and certificates.
• Training programs promoting continuous learning and career progression.
• Sustainability programs supporting community engagement.
• Culture of respect, collaboration, entrepreneurial spirit, and inclusion.