Medical Case Manager

Crawford & Company; Portland (OR); Remote; USD 60,000 - 90,000; Full time

Job summary

An established industry player is seeking a dedicated Medical Case Manager to work from home while providing essential case management services. This role requires local travel to assess and support clients in various settings, ensuring compliance with industry standards. You will collaborate with a diverse team, including claims adjusters and healthcare providers, to optimize case outcomes. The position offers a great work-life balance and opportunities for professional development, including reimbursement for licenses and certifications. If you are passionate about making a difference in people's lives and have a strong clinical background, 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

• RN degree required; BSN preferred.
• 1-3 years clinical experience, preferably in Workers' Compensation case management.

Responsibilities

• Provide effective case management services in accordance with URAC standards.
• Conduct job site evaluations and facilitate timely return-to-work processes.

Skills

Kommunikation

Analytische Fähigkeiten

Organisationsfähigkeiten

Führungskompetenzen

Education

RN Degree

BSN Degree

Tools

Microsoft Office

Lotus Notes

Job description

Job Description: Medical Case Manager - Work from Home (Portland, OR)

Benefits:

• 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 for field case management.

Responsibilities:

1. Provide effective case management services in accordance with URAC standards, CMSA Standards of Practice, and Broadspire QA Guidelines for various insurance benefits including Workers' Compensation, Group Health, Liability, Disability, and Care Management.
2. Review case records, analyze data, evaluate medical status, identify needs and obstacles, and provide proactive case management.
3. Render opinions on case costs, treatment plans, outcomes, and facilitate return-to-work solutions.
4. Establish collaborative relationships with claims adjusters, employers, patients, attorneys, and colleagues.
5. Gather and analyze data to improve case management processes and outcomes.
6. Maintain documentation and meet productivity and QA standards.
7. Conduct job site evaluations and facilitate timely return-to-work processes.
8. Communicate regularly with claims adjusters, physicians, and employers regarding case status.
9. Perform site visits, reviews, and coordinate medical record reviews and referrals.
10. Travel approximately 70% of the time to various locations including homes, healthcare providers, and workplaces.
11. Adhere to company policies and demonstrate excellent customer service.

Minimum Requirements:

• RN degree required; BSN preferred.
• 1-3 years clinical experience; Workers' Compensation case management experience preferred.
• Active RN license in good standing.
• National Certification such as CCM, CRC, COHN, CRRC preferred; if not, plan to obtain within 36 months.
• Knowledge of case management practices, excellent communication, analytical, organizational, and leadership skills.
• Computer proficiency with Microsoft Office and Lotus Notes.
• Must meet state-specific requirements for case management services and be compliant with COVID-19 vaccination laws.
• Valid driver's license and ability to travel as required.