Medical Case Manager

Crawford & Company in; Detroit (MI); Remote; USD 65,000 - 85,000; Full time

Job summary

A leading company is seeking a Medical Case Manager in the Detroit region for a work-from-home position. The role involves providing comprehensive medical case management services while adhering to URAC and CMSA standards. Candidates must possess an Associate's degree in Nursing and relevant national certifications, with at least 1-3 years of clinical experience. The position requires extensive travel within the region and excellent communication and analytical skills to effectively manage case resolutions and support the return-to-work process.

Benefits

Free CEUs for licenses and certificates

License and national certification reimbursement

Qualifications

• Licensure as an RN in Michigan with no restrictions.
• Minimum of 1 National Certification (CCM, COHN, etc.) is preferred.
• 1-3 years of diverse clinical experience.

Responsibilities

• Provide medical case management services according to URAC and CMSA standards.
• Travel approximately 70% of the work time for case management.
• Facilitate timely return-to-work solutions for injured workers.

Skills

Communication

Problem-solving

Analytical Skills

Customer Service Skills

Organizational Skills

Education

Associate's degree in Nursing

BSN Degree

Job description

• Free CEU's for licenses and certificates

• License and national certification reimbursement

This is a work from home position requiring local field case management travel to cover the Detroit, Michigan region.

• National Certification such as CCM, CRC, COHN, CRRC preferred

To provide effective case management services in an appropriate, cost-effective manner. Provides medical case management service which is consistent with URAC standards and CMSA Standards of Practice and Broadspire Quality Assurance (QA) Guidelines to patients/employees who are receiving benefits under an Insurance Line including but not limited to Workers' Compensation, Group Health, Liability, Disability, and Care Management.

• 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);
• 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 communication 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.
• Based on federal, state, or local law, this position may require you to be fully vaccinated for COVID-19.
• 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 the next 36 months.
• National certification must be obtained to reach Senior Medical Case Management status.
• Travel may entail approximately 70% of work time.
• Must maintain a valid driver's license in the 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 make recommendations to facilitate case management goals including RTW.
• Demonstrates ability to meet administrative requirements, including productivity, time management, and QA standards, with minimal supervisory intervention.
• May perform job site evaluations/summaries to facilitate case management process.
• Facilitates timely return to work by establishing a professional working relationship with the injured worker/disabled individual, physician, and employer. Coordinates RTW with injured worker, employer, and physicians.
• Maintains contact and communicates with claims adjusters to update on case activity, case direction, or to secure authorization for services. Maintains contact with all parties involved in case management of 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 IMEs 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 assessments accordingly.
• May spend approximately 70% of work time traveling to homes, healthcare providers, job sites, and various offices as required to facilitate RTW and case resolution.
• Meets monthly production and QA requirements to ensure quality standards.
• Reviews cases with supervisor monthly for evaluation and guidance.
• Upholds the Crawford and Company Code of Business Conduct at all times.
• Demonstrates excellent customer service and respect for customers, co-workers, and management.
• Approaches problem-solving independently using research and resources.
• Performs other related duties as assigned.