Medical Case Manager

Crawford & Company; Oregon, Portland (IL, OR); Remote; USD 60,000 - 100,000; Full time

Job summary

An established industry player is seeking a dedicated case manager to provide exceptional support in a work-from-home setting. This role involves local travel within the Portland region, ensuring effective case management services across various insurance lines. You'll leverage your clinical expertise to guide clients through their recovery journeys, all while working independently and meeting productivity standards. Join a dynamic team that values collaboration, innovation, and a commitment to restoring lives. If you're passionate about making a difference in the community and have the required qualifications, this opportunity is perfect for you.

Benefits

Quarterly Bonus Program

Free CEUs for licenses and certificates

License and national certification reimbursement

Work-life balance initiatives

Training programs for career growth

Qualifications

• RN degree required with national certification preferred.
• 1-3 years of clinical experience and knowledge of workers' compensation.

Responsibilities

• Provide effective case management services for various insurance lines.
• Analyze data and evaluate medical status for case resolution.

Skills

Case Management

Communication Skills

Analytical Skills

Organizational Skills

Education

Associate's Degree in Nursing

Bachelor of Science in Nursing (BSN)

Tools

URAC Standards

CMSA Standards of Practice

Job description

Benefits and Position Details

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 travel within the Portland, OR region.

Qualifications

• RN degree required
• National Certification such as CCM, CRC, COHN, CRRC preferred
• Prior Workers Compensation Case Management preferred

Responsibilities

• Provide effective case management services in accordance with URAC standards, CMSA Standards of Practice, and Broadspire QA Guidelines for various insurance lines including Workers' Compensation, Group Health, Liability, Disability, and Care Management.
• Review case records, analyze data, evaluate medical status, and identify needs and obstacles to medical case resolution and RTW, providing proactive services.
• Offer opinions on case costs, treatment plans, and outcomes, and make recommendations to facilitate RTW goals.
• Meet administrative, productivity, time management, and QA standards with minimal supervision.
• Perform job site evaluations if needed to support case management.
• Facilitate timely RTW by establishing relationships with injured workers, physicians, and employers, and coordinating efforts.
• Maintain communication with claims adjusters and other involved parties, and manage case documentation and referrals as needed.
• Utilize clinical expertise to interpret medical records and test results.
• Travel approximately 70% of the time to homes, healthcare providers, job sites, and offices.
• Meet monthly production and QA requirements, review cases with supervisors, and uphold the company's Code of Business Conduct.
• Demonstrate excellent customer service, problem-solving skills, and the ability to work independently.

Minimum Qualifications

• Associate's degree or relevant coursework in Nursing; BSN preferred.
• 1-3 years of clinical experience and certification as a case manager from an URAC-approved list preferred, or RN licensure.
• Knowledge of case management practices and workers' compensation products.
• Excellent communication, analytical, organizational skills, and computer proficiency.
• Ability to establish collaborative relationships with various stakeholders.
• Must be compliant with state requirements and hold an active RN license in good standing.
• Minimum of one national certification (e.g., CCM, CDMS, CRRN, COHN), with a plan to obtain if not already certified.
• Travel approximately 70% of the time; valid driver's license required.

Additional Information

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Why Crawford?

Because a claim is more than a number — it's a person, a child, a friend. It's anyone who looks to Crawford on their worst days. And by helping to restore their lives, we are helping to restore our community — one claim at a time.

At Crawford, employees are empowered to grow, emboldened to act, and inspired to innovate. Our industry-leading team pioneers new solutions for the industries and customers we serve. We're looking for the next generation of leaders to join us.

We hail from more than 70 countries and speak dozens of languages, reflecting our diverse workforce. Though our reach is vast, we operate as One Crawford: united in purpose, vision, and values. Learn more at www.crawco.com.

When you accept a job with Crawford, you become part of the One Crawford family.

Our total compensation plans include:

• Pay and incentive plans recognizing performance excellence
• Benefit programs supporting financial, physical, and mental wellness
• Training programs for continuous learning and career growth
• Sustainability initiatives that give back to our communities
• A culture of respect, collaboration, entrepreneurial spirit, and inclusion

Crawford & Company participates in E-Verify and is an Equal Opportunity Employer. We do not accept unsolicited assistance from search firms. Resumes submitted without a valid Statement of Work will be property of Crawford, and no fee will be paid unless the candidate is hired through a formal agreement.