Medical Case Manager

Crawford & Company in; Portland (OR); Remote; USD 50,000 - 80,000; Full time

Job summary

An established industry player is seeking a dedicated Case Manager to provide effective case management services while ensuring compliance with various standards. This role involves local field case management travel, where you will support patients across different insurance lines. Ideal candidates will possess a strong nursing background, excellent communication skills, and a commitment to patient care. Join a forward-thinking team that values your expertise and offers opportunities for professional growth while making a meaningful impact on patients' lives.

Benefits

Free CEUs for licenses and certificates

License and national certification reimbursement

Qualifications

• 1-3 years of clinical experience required.
• Active RN license in good standing is necessary.

Responsibilities

• Provide effective case management services ensuring compliance with standards.
• Maintain communication with all parties involved in case management.

Skills

Communication Skills

Analytical Skills

Customer Service

Organizational Skills

Leadership Skills

Basic Computer Skills

Education

Associate's Degree in Nursing

BSN (Bachelor of Science in Nursing)

Tools

Microsoft Office

Lotus Notes

Job description

Job Benefits

• Free CEUs for licenses and certificates
• License and national certification reimbursement

Position Details

This is a work-from-home position requiring local field case management travel to cover the Portland, OR region.

Preferred Certifications

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

Job Responsibilities

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

Qualifications

• Associate's degree or relevant coursework/certification in Nursing required; BSN preferred
• 1-3 years of diverse clinical experience
• Certification as a case manager from the URAC-approved list preferred
• Must comply with state requirements regarding national certifications
• Knowledge of case management practices and workers' compensation products
• Excellent communication, analytical, customer service, organizational, and leadership skills
• Basic computer skills including Microsoft Office and Lotus Notes
• Active RN license in good standing; must meet specific requirements for medical case management services
• Minimum of 1 National Certification (preferred: CCM, CDMS, CRRN, COHN); plan to obtain if not certified within 36 months
• Willingness to travel approximately 70% of the time
• Valid driver's license in the state of residence

Additional Requirements

• Review case records, evaluate medical status, and coordinate return-to-work plans
• Maintain communication with all parties involved in case management
• May perform site evaluations, facilitate timely RTW, and review files for case appropriateness
• Utilize clinical expertise to interpret medical records and test results
• Travel extensively to homes, healthcare providers, and workplaces
• Meet monthly productivity and QA standards
• Uphold the company's Code of Business Conduct and demonstrate excellent customer service
• Perform other duties as assigned