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Medical Case Manager
2 months ago
Crawford & Company is seeking a highly skilled Medical Case Manager to join our team. As a Medical Case Manager, you will play a critical role in restoring the lives of individuals who have been injured or are experiencing health issues.
Key Responsibilities- Provide effective case management services to patients/employees who are receiving benefits under an Insurance Line, including Workers' Compensation, Group Health, Liability, Disability, and Care Management.
- 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, and make recommendations to facilitate case management goals, including Return to Work (RTW).
- Establish a professional working relationship with the injured worker/disabled individual, physician, and employer to facilitate timely RTW.
- Maintain contact and communicate with claims adjusters to apprise them of case activity, case direction, or secure authorization for services.
- Utilize clinical expertise and medical resources to interpret medical records and test results and provide assessment accordingly.
- May spend approximately 70% of work time traveling to homes, healthcare providers, job sites, and various offices as required to facilitate RTW and resolution of cases.
- Associate's degree or relevant coursework/certification in Nursing is required; BSN Degree is preferred.
- Minimum of 1-3 years diverse clinical experience and one of the following: Certification as a case manager from the URAC-approved list of certifications (preferred); A registered nurse (RN) license.
- Must be compliant with state requirements regarding national certifications.
- 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 proceeding 36 months.
- National certification must be obtained in order 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.
Crawford & Company offers a comprehensive compensation package, including pay and incentive plans that recognize performance excellence, benefit programs that empower financial, physical, and mental wellness, training programs that promote continuous learning and career progression, and a culture of respect, collaboration, entrepreneurial spirit, and inclusion.