Medical Case Manager

Crawford & Company in; Naples (FL); Remote; USD 70,000 - 90,000; Full time

Job summary

A leading company in healthcare management is seeking a Medical Case Manager to provide effective case management services. This position requires an RN licensure and national certification, with extensive travel to support clients in the Southwest Florida region, including Fort Myers and Naples. The ideal candidate will have strong communication and analytical skills, along with a commitment to maintaining high standards of patient care and documentation.

Benefits

Free CEUs for licenses and certificates

License and national certification reimbursement

Qualifications

• Minimum 1-3 years diverse clinical experience required.
• Certification as a case manager preferred.
• Must have at least 1 National Certification within 36 months.

Responsibilities

• Provide proactive case management services and solutions.
• Travel approximately 70% of work time to meet clients.
• Review case records, analyze data, and communicate regularly.

Skills

Communication

Analytical skills

Customer service

Organizational skills

Leadership

Education

Associate's degree or relevant nursing coursework/certification

BSN Degree (preferred)

Active RN licensure in home state

Tools

Microsoft Office

Lotus Notes

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 Southwest, FL, including Fort Myers, Naples, and surrounding regions.

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

To provide effective case management services in an appropriate, cost-effective manner. Provides medical case management services consistent with URAC standards, CMSA Standards of Practice, and Broadspire QA Guidelines to patients/employees receiving benefits under various insurance lines including Workers' Compensation, Group Health, Liability, Disability, and Care Management.

• Associate's degree or relevant coursework/certification in Nursing is required; BSN Degree preferred.
• Minimum of 1-3 years diverse clinical experience with one of the following:
• Certification as a case manager from the URAC-approved list (preferred);
• Must comply with state requirements regarding national certifications.
• Basic knowledge of case management practices and ability to quickly learn workers' compensation/case management products and services.
• Excellent oral and written communication skills for facilitating return-to-work solutions and ensuring quality documentation.
• Strong analytical and customer service skills to resolve case management issues.
• Basic computer skills, including Microsoft Office and Lotus Notes.
• Ability to establish collaborative relationships with claims adjusters, employers, patients, attorneys, and colleagues.
• Skill in data gathering and analysis to improve trends, processes, and outcomes.
• Organizational skills to handle multiple tasks efficiently.
• Leadership abilities with understanding of supervisory principles.
• Position may require COVID-19 vaccination based on legal requirements.
• Active RN licensure in good standing in the home state.
• Must meet specific requirements to provide medical case management services.
• Minimum of 1 National Certification (CCM, CDMS, CRRN, COHN) preferred; if not, plan to obtain within 36 months.
• National certification is required for Senior Medical Case Management status.
• Travel may constitute approximately 70% of work time.
• Maintain a valid driver's license.
• Review case records, analyze data, evaluate medical status, identify needs, and provide proactive case management services.
• Provide opinions on case costs, treatment plans, and outcomes, and recommend solutions to facilitate RTW.
• Meet administrative and QA standards with minimal supervision.
• May perform job site evaluations to support case management.
• Establish professional relationships to facilitate timely RTW, coordinating with injured workers, employers, and physicians.
• Communicate regularly with claims adjusters and involved parties.
• Obtain and review medical records, facilitate referrals, and interpret medical information.
• Spend approximately 70% of work time traveling to homes, healthcare providers, job sites, and offices.
• Meet monthly productivity 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.