Healthcare Case Management Specialist

2 weeks ago


Modesto, California, United States Crawford & Company Full time
Position Overview

As a Healthcare Case Management Specialist, you will play a crucial role in delivering comprehensive medical case management services. This position is designed for professionals who are dedicated to ensuring optimal outcomes for patients receiving benefits across various insurance lines.

Key Responsibilities
  • Field Case Management: This role requires local travel to facilitate case management activities.
  • Medical Case Management: Provide services that align with URAC standards and CMSA Standards of Practice, ensuring quality assurance in all interactions.
  • Data Analysis: Review case records, collect and analyze data, and evaluate the medical status of individuals to identify needs and barriers to resolution.
  • Collaboration: Maintain effective communication with claims adjusters to keep them informed of case progress and secure necessary authorizations.
  • Referral Management: Coordinate referrals for peer reviews and independent medical examinations by managing medical records and liaising with healthcare providers.
  • Clinical Expertise: Utilize your clinical knowledge to interpret medical documentation and provide informed assessments.
  • Travel Requirements: Expect to spend a significant portion of your time traveling to various locations to facilitate return-to-work initiatives.
Qualifications
  • Education: An Associate's degree or relevant coursework in Nursing is required; national certification is necessary for advancement.
  • Licensure: Active RN licensure in good standing is mandatory.
  • Communication Skills: Excellent verbal and written communication abilities are essential for effective collaboration.
  • Technical Skills: Proficiency in Microsoft Office and basic computer skills are required.
  • Interpersonal Skills: Demonstrated ability to build collaborative relationships with various stakeholders.
  • Analytical Skills: Proven capability to gather and analyze data to enhance processes and outcomes.
Why Join Us?

At Crawford & Company, we are committed to fostering a culture of respect, collaboration, and inclusion. We offer competitive pay and benefits that support your financial, physical, and mental well-being. Our training programs are designed to promote continuous learning and career growth, while our sustainability initiatives reflect our dedication to giving back to the communities we serve.



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