Medical Case Manager

Crawford & Company; Louisville (KY); Remote; USD 50,000 - 80,000; Full time

Job summary

An established industry player is seeking a dedicated Case Manager for a work-from-home position. This role involves providing effective case management services, evaluating medical statuses, and facilitating return-to-work processes. The ideal candidate will have clinical experience, strong communication skills, and a commitment to excellence. Join a supportive team that values collaboration and continuous learning while making a positive impact on lives and communities. This position offers a great work-life balance and opportunities for professional growth.

Benefits

Great Work Life Balance

Quarterly Bonus Program

Free CEUs for licenses and certificates

License and national certification reimbursement

Qualifications

• 1-3 years of clinical experience and certification as a case manager preferred.
• Active RN license in good standing and compliance with state requirements.

Responsibilities

• Provide effective case management services consistent with URAC and CMSA standards.
• Establish relationships with injured workers and healthcare providers to facilitate RTW.

Skills

Clinical Experience

Case Management Practices

Communication Skills

Analytical Skills

Organizational Skills

Problem-Solving Skills

Education

Associate's Degree in Nursing

BSN

National Certification (CCM, CDMS, CRRN, COHN)

Tools

Case Management Software

Microsoft Office Suite

Job description

* Great Work Life Balance!

* Quarterly Bonus Program!

* Free CEUs for licenses and certificates

* License and national certification reimbursement

This is a work-from-home position requiring local field case management travel to cover Louisville, KY, and surrounding region counties, as well as Southern Indiana.

Responsibilities:

1. Provide effective case management services in a cost-effective manner, consistent with URAC standards, CMSA Standards of Practice, and Broadspire QA Guidelines for various insurance benefits.
2. Review case records, evaluate medical status, identify needs, and facilitate medical case resolution and RTW (Return to Work).
3. Render opinions on case costs, treatment plans, and outcomes, making recommendations to achieve case management goals.
4. Meet administrative requirements including productivity, time management, and QA standards with minimal supervision.
5. Perform job site evaluations to support case management.
6. Establish professional relationships with injured workers, physicians, and employers to facilitate RTW.
7. Communicate regularly with claims adjusters, employers, and healthcare providers regarding case activity.
8. Obtain and review medical records, coordinate referrals for peer reviews and IMEs, and interpret medical information.
9. Travel approximately 70% of the work time to various locations to facilitate case resolution.
10. Meet monthly production and QA requirements, review cases with supervisors, and uphold company codes and standards.
11. Demonstrate excellent customer service, problem-solving skills, and the ability to work independently.

Minimum Requirements:

• Associate's degree or relevant coursework in Nursing; BSN preferred.
• 1-3 years clinical experience and certification as a case manager (preferred) or RN license.
• Knowledge of case management practices and workers' compensation products.
• Excellent communication, analytical, organizational, and computer skills.
• Active RN license in good standing and ability to meet state-specific requirements.
• Minimum of 1 National Certification (CCM, CDMS, CRRN, COHN) preferred, with a plan to obtain if not already certified.
• Must maintain a valid driver’s license and be willing to travel up to 70% of the time.
• Compliance with COVID-19 vaccination requirements as per law.

Why Crawford?

Because a claim is more than a number — it's a person, a child, a friend. At Crawford, we help restore lives and communities, fostering growth, innovation, and leadership among our employees. Join us and be part of a global team that values respect, collaboration, and inclusion.

Our benefits include performance-based incentives, wellness programs, continuous learning opportunities, community giving, and a culture of respect and entrepreneurial spirit.

Crawford & Company participates in E-Verify and is an Equal Opportunity Employer. Unsolicited search firm resumes will not be accepted without a valid Statement of Work.