Medical Case Manager

Crawford & Company; Atlanta (GA); Remote; USD 65,000 - 95,000; Full time

Benefits offered by this job

Quarterly bonus opportunities

Free CEUs for licenses & certificates

License & Certification reimbursement

Job summary

Crawford & Company is hiring an RN Case Manager in the Atlanta, GA region. This remote role includes local field travel, with a strong emphasis on cost-effective medical case management aligned to URAC standards and CMSA guidelines.

Expect involvement with Workers' Comp, Group Health, Liability, and Disability programs. The ideal candidate has an RN license, 1–3 years of diverse clinical experience, and national certification (CCM/CRC/COHN/CRRN) with travel up to 70%.

Qualifications

• RN degree required.
• National Certification required (CCM, CRC, COHN, CRRN).
• 1–3 years diverse clinical experience.
• RN license in home state; active in good standing.
• Willingness to travel up to ~70% and comply with licensure requirements.

Responsibilities

• Review and manage case records, data, and RTW plans.
• Coordinate with claims, employers, and healthcare providers to facilitate case resolution.
• Ensure QA standards and timely documentation are met.
• Travel to patient sites, providers, and offices as needed.
• Maintain professional relationships with all stakeholders.

Skills

Case management

Communication skills

Analytical skills

Organizational skills

Leadership

Travel readiness

Customer service

Problem solving

Education

RN degree

Associate's degree in Nursing

BSN preferred

National Certification (CCM/CRC/COHN/CRRN)

Job description

Now Hiring: RN Case Manager - Atlanta, GA Region

Remote position + local field travel

Salary: Competitive & commensurate with experience

Quarterly Bonus Opportunities

Free CEUs for licenses & certificates

License & Certification Reimbursement

We're looking for an RN with a passion for case management to join our team!

• RN degree required
• National Certification required (CCM, CRC, COHN, CRRN)
• Workers' Comp Case Management experience a plus

Your Impact: 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.

This is your chance to grow your career, earn great rewards, and enjoy true work-life balance.

• Associate's degree or relevant course work/certification in Nursing is required; BSN Degree is preferred.
• Minimum of 1-3 years diverse clinical experience and one of the below:
• 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.
• 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 effectively 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.
• Excellent organizational skills as evidenced by proven ability to handle multiple tasks simultaneously.
• Demonstrated leadership ability with a basic understanding of supervisory and management principles.
• 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.

• Reviews case records and reports, collects and analyzes data, evaluates injured worker/disabled individual's medical status, identifies needs and obstacles to medical case resolution and RTW by providing proactive case management services.
• Render opinions regarding case costs, treatment plan, outcome and problem areas, and makes recommendations to facilitate case management goals to include RTW.
• Demonstrates ability to meet administrative requirements, including productivity, time management and QA standards, with a minimum of supervisory intervention.
• May perform job site evaluations/summaries to facilitate case management process.
• Facilitates timely return to work date by establishing a professional working relationship with the injured worker/disabled individual, physician, and employer. Coordinate RTW with injured worker, employer and physicians.
• Maintains contact and communicates with claims adjusters to apprise them of case activity, case direction or secure authorization for services. Maintains contact with all parties involved on case, necessary for case management the injured worker/disabled individual.
• May obtain records from the branch claims office.
• May review files for claims adjusters and supervisors for appropriate referral for case management services.
• May meet with employers to review active files.
• Makes referrals for Peer reviews and IME's by obtaining and delivering medical records and diagnostic films, notifying injured worker/disabled individual and conferring with physicians.
• Utilizes clinical expertise and medical resources to interpret medical records and test results and provides assessment accordingly.
• May spend approximately 70% of their work time traveling to homes, health care providers, job sites and various offices as required facilitating RTW and resolution of cases.
• Meets monthly production requirements and quality assessment (QA) requirements to ensure a quality product.
• Reviews cases with supervisor monthly to evaluate files and obtain directions.
• Upholds the Crawford and Company Code of Business Conduct at all times.
• Demonstrates excellent customer service, and respect for customers, co-workers, and management.
• Independently approaches problem solving by appropriate use of research and resources.
• May perform other related duties as assigned.