Medical Case Manager

Crawford & Company in; Grand Rapids (MI); Remote; USD 50,000 - 80,000; Full time

Job summary

An established industry player is seeking a dedicated case manager to provide effective case management services while ensuring compliance with industry standards. This work-from-home position requires local travel within the Grand Rapids region, making it a perfect opportunity for those who thrive in dynamic environments. Ideal candidates will have clinical experience, strong communication skills, and a commitment to delivering exceptional customer service. Join a team that values collaboration and excellence, and make a meaningful impact in the lives of those you serve.

Benefits

Free CEUs for licenses and certificates

License and national certification reimbursement

Qualifications

• 1-3 years of clinical experience required.
• Active RN licensure in good standing is mandatory.

Responsibilities

• Provide effective case management services ensuring compliance with standards.
• Manage cases for patients receiving benefits under various insurance lines.

Skills

Communication Skills

Analytical Skills

Customer Service Skills

Organizational Skills

Leadership Skills

Basic Computer Skills

Education

Associate's Degree in Nursing

BSN (Bachelor of Science in Nursing)

Tools

Microsoft Office

Lotus Notes

Job description

Job Benefits and Requirements

• Free CEUs for licenses and certificates

• License and national certification reimbursement

This is a work-from-home position requiring local travel within the Grand Rapids, MI region.

Responsibilities

Provide effective case management services in a cost-effective manner, ensuring compliance with URAC standards, CMSA Standards of Practice, and Broadspire QA Guidelines. Manage cases for patients/employees receiving benefits under various insurance lines including Workers' Compensation, Group Health, Liability, Disability, and Care Management.

Qualifications

• Associate's degree or relevant coursework/certification in Nursing; BSN preferred.
• 1-3 years of diverse clinical experience.
• Certification as a case manager from the URAC-approved list is preferred; compliance with state certification requirements is mandatory.
• Knowledge of case management practices and ability to quickly learn workers' compensation/case management products.
• Excellent communication skills, both oral and written.
• Strong analytical and customer service skills.
• Basic computer skills, including Microsoft Office and Lotus Notes.
• Ability to establish collaborative relationships with claims adjusters, employers, patients, attorneys, and colleagues.
• Ability to analyze data and develop improvement plans.
• Strong organizational skills with the ability to handle multiple tasks.
• Leadership skills with a basic understanding of supervisory principles.
• Active RN licensure in good standing; specific requirements for medical case management services must be met.
• Minimum of 1 national certification (e.g., CCM, CDMS, CRRN, COHN); plan to attain certification within 36 months if not already certified.
• Willingness to travel approximately 70% of the time.
• Valid driver's license in the state of residence.

Additional Duties

• Review case records, evaluate medical status, and identify needs and obstacles to recovery and return-to-work.
• Provide opinions on case costs, treatment plans, and outcomes, and make recommendations.
• Meet productivity, time management, and QA standards.
• Perform site evaluations and facilitate timely return-to-work processes.
• Communicate regularly with claims adjusters, physicians, and employers.
• Obtain and review medical records, coordinate referrals, and interpret medical information.
• Travel to homes, healthcare providers, and job sites as needed.
• Meet monthly production and QA requirements.
• Review cases with supervisors and uphold company conduct standards.
• Demonstrate excellent customer service and problem-solving skills.
• Perform other duties as assigned.