Medical Case Manager

Crawford & Company; Philadelphia (Philadelphia County); Remote; USD 60,000 - 90,000; Full time

Job summary

An established industry player is seeking a dedicated Medical Case Manager to provide remote case management services. In this role, you will leverage your clinical expertise to evaluate medical statuses and facilitate return-to-work processes for patients under various insurance lines. This position offers a great work-life balance, along with opportunities for professional development through free CEUs and a quarterly bonus program. If you are passionate about making a difference in patients' lives and enjoy working collaboratively with stakeholders, this role is perfect for you.

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, preferably in Workers' Compensation case management.
• Active RN license in good standing; national certification preferred.

Responsibilities

• Provide effective case management services for various insurance lines.
• Conduct job site evaluations and facilitate return-to-work processes.

Skills

Communication Skills

Data Analysis

Case Management Practices

Clinical Experience

Education

RN Degree

BSN

Tools

Case Management Software

Job description

Job Description: Medical Case Manager (Work from Home, Phoenix, AZ)

Benefits:

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

This is a remote position requiring local travel within the Phoenix, AZ region for field case management.

Responsibilities:

1. Provide effective, cost-efficient case management services adhering to URAC, CMSA, and Broadspire QA standards for patients/employees under various insurance lines, including Workers' Compensation, Group Health, Liability, Disability, and Care Management.
2. Review case records, analyze data, evaluate medical status, and identify needs and obstacles 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. Maintain documentation standards, ensure timely communication with all parties involved, and meet productivity and QA standards.
5. Conduct job site evaluations, facilitate RTW, and coordinate with injured workers, employers, and physicians.
6. Communicate regularly with claims adjusters, physicians, and other stakeholders to update case status and obtain necessary authorizations.
7. Perform travel up to approximately 70% of the time to homes, healthcare providers, and job sites.
8. Meet monthly production and quality requirements, review cases with supervisors, and uphold company policies and customer service standards.

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 (e.g., CCM, CRC, COHN, CRRC) preferred, with plans to obtain if not already certified.
• Knowledge of case management practices, excellent communication skills, and computer proficiency.
• Ability to establish collaborative relationships and analyze data for process improvement.
• Must meet legal requirements, including possibly being vaccinated for COVID-19.
• Valid driver's license and willingness to travel as required.