Medical Case Manager- CA

Crawford & Company; Wellesley (MA); Remote; USD 60,000 - 95,000; Full time

Job summary

An innovative firm seeks a dedicated Medical Case Manager to provide exceptional case management services remotely. This role involves local field travel, ensuring patients receive the best care under various insurance lines. You will analyze medical data, coordinate with stakeholders, and uphold high standards of customer service. Join a company that values work-life balance and offers generous benefits, including a quarterly bonus program and reimbursement for licenses. If you're passionate about making a difference in the lives of others and thrive in a collaborative environment, this opportunity is perfect for you.

Benefits

Great Work Life Balance

Quarterly Bonus Program

Free CEUs for licenses and certificates

License reimbursement

Qualifications

• RN degree required; BSN preferred.
• 1-3 years clinical experience; national certification preferred.

Responsibilities

• Providing effective case management services in accordance with standards.
• Maintaining contact with claims adjusters, employers, and physicians.

Skills

Kommunikationsfähigkeiten

Analytische Fähigkeiten

Organisatorische Fähigkeiten

Kundenservicefähigkeiten

Microsoft Office Kenntnisse

Education

RN Degree

BSN

Tools

Microsoft Office

Job description

Job Description: Medical Case Manager (Work from Home, San Jose, CA)

Benefits:

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

Position Overview:

This is a work from home position requiring local field case management travel to cover the San Jose, CA region.

Responsibilities include:

1. Providing effective case management services in accordance with URAC standards, CMSA Standards of Practice, and Broadspire QA Guidelines to patients/employees receiving benefits under various insurance lines.
2. Reviewing case records, analyzing data, evaluating medical status, and facilitating return-to-work solutions.
3. Maintaining contact with claims adjusters, employers, physicians, and injured workers to coordinate case management and RTW efforts.
4. Performing site evaluations, reviewing files, and making referrals for peer reviews and IMEs.
5. Traveling approximately 70% of the time to homes, healthcare providers, job sites, and offices.
6. Meeting monthly productivity and QA standards.
7. Upholding company policies and demonstrating excellent customer service and professionalism.

Qualifications:

• RN degree required; BSN preferred.
• 1-3 years clinical experience; national certification such as CCM, CRC, COHN, CRRC preferred.
• Active RN license in good standing.
• Knowledge of case management practices and workers' compensation services.
• Strong communication, analytical, organizational, and customer service skills.
• Basic computer skills, including Microsoft Office.
• Ability to establish collaborative relationships with various stakeholders.
• Must meet state requirements for providing medical case management services.
• Must maintain a valid driver's license and meet travel requirements.
• Based on law, COVID-19 vaccination may be required.