Medical Case Manager

Crawford & Company; Peachtree Corners (GA); Remote; USD 60,000 - 90,000; Full time

Job summary

An established industry player is seeking a dedicated Medical Case Manager to join their team. This work-from-home position offers a great work-life balance and the opportunity to make a significant impact on patients' lives. You'll be responsible for managing cases effectively, collaborating with various stakeholders, and ensuring compliance with industry standards. With a focus on professional growth, the role includes a quarterly bonus program and reimbursement for licenses and certifications. If you're passionate about case management and looking for a fulfilling career, this opportunity is perfect for you.

Benefits

Great Work Life Balance

Quarterly Bonus Program

Free CEUs for licenses and certificates

License and national certification reimbursement

Qualifications

• RN degree required; BSN preferred.
• 1-3 years of clinical experience; Workers Compensation case management experience preferred.

Responsibilities

• Provide effective case management services in accordance with URAC standards.
• Establish collaborative relationships with claims adjusters, employers, and patients.

Skills

Clinical Experience

Communication Skills

Analytical Skills

Organizational Skills

Case Management Knowledge

Education

RN Degree

BSN

Tools

Medical Records Software

Data Analysis Tools

Job description

Job Title: Medical Case Manager (Work from Home)

Benefits:

• Great Work Life Balance!
• Quarterly Bonus Program!
• Free CEUs for licenses and certificates
• License and national certification reimbursement

Position Details: This is a work from home position requiring local travel to cover Louisville, KY and surrounding counties, as well as Southern Indiana.

Responsibilities:

1. Provide effective case management services in accordance with URAC standards, CMSA Standards of Practice, and Broadspire QA Guidelines for patients/employees receiving benefits under various insurance lines.
2. Review case records, analyze data, evaluate medical status, and identify needs to facilitate case resolution and return-to-work (RTW).
3. Render opinions on case costs, treatment plans, and outcomes; make recommendations to meet case management goals.
4. Establish collaborative relationships with claims adjusters, employers, patients, attorneys, and colleagues.
5. Gather and analyze data to improve trends, processes, and outcomes.
6. Meet productivity, time management, and QA standards with minimal supervision.
7. Perform job site evaluations and facilitate timely RTW by coordinating with injured workers, employers, and physicians.
8. Maintain communication with claims adjusters and involved parties, and manage case documentation.
9. Review files, make referrals for peer reviews and IMEs, and interpret medical records and test results.
10. Travel approximately 70% of the time to homes, healthcare providers, job sites, and offices.
11. Meet monthly production and quality requirements.
12. Uphold company standards and demonstrate excellent customer service and professionalism.

Qualifications:

• RN degree required; BSN preferred.
• 1-3 years of clinical experience; Workers Compensation case management experience preferred.
• Active RN license in good standing.
• National certification such as CCM, CRC, COHN, CRRC preferred; plan to obtain certification within 36 months if not already certified.
• Knowledge of case management practices and ability to learn quickly.
• Excellent communication, analytical, organizational, and computer skills.
• Valid driver's license and ability to travel as required.
• Compliance with COVID-19 vaccination requirements may apply depending on law.