Medical Case Manager Part-Time

Crawford & Company in; San Antonio (TX); Remote; USD 40,000 - 70,000; Part time

Job summary

An established industry player is seeking a dedicated Medical Case Manager for a part-time, work-from-home role with local travel. This position offers a great work-life balance and includes a quarterly bonus program, along with reimbursement for licenses and certifications. The ideal candidate will possess an RN degree and relevant certifications, coupled with strong communication and analytical skills. You will be responsible for delivering cost-effective case management services, ensuring compliance with industry standards, and collaborating with various stakeholders to facilitate timely return-to-work solutions. If you are passionate about making a difference in the healthcare field, 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 with national certifications preferred.
• 1-3 years of clinical experience in case management.

Responsibilities

• Provide effective case management services under various insurance lines.
• Analyze case records and facilitate return-to-work efforts.

Skills

Communication Skills

Analytical Skills

Customer Service Skills

Data Analysis

Organizational Skills

Education

Associate's Degree in Nursing

Bachelor of Science in Nursing (BSN)

Tools

Microsoft Office

Lotus Notes

Job description

Medical Case Manager Part-Time (Finance)

• Great Work Life Balance!

• Quarterly Bonus Program!

• Free CEUs for licenses and certificates

• License and national certification reimbursement

This is a part-time work-from-home position requiring local travel within the Houston, TX region for field case management.

• RN degree required
• National certifications such as CCM, CRC, COHN, CRRC are preferred
• Prior workers' compensation case management experience is preferred

The role involves providing effective, cost-efficient case management services in accordance with URAC standards, CMSA Standards of Practice, and Broadspire QA Guidelines. Services are delivered to patients/employees under various insurance lines including Workers' Compensation, Group Health, Liability, Disability, and Care Management.

• An associate's degree or relevant coursework/certification in Nursing is required; a BSN is preferred.
• 1-3 years of diverse clinical experience and one of the following:
• Certification from the URAC-approved list (preferred); or
• An active RN license.
• Compliance with state requirements regarding national certifications is mandatory.
• Basic knowledge of case management practices and the ability to quickly learn workers' compensation products and services.
• Excellent communication skills, both oral and written, for effective collaboration and documentation.
• Strong analytical and customer service skills to resolve case management issues.
• Proficiency with Microsoft Office and Lotus Notes.
• Ability to build collaborative relationships with claims adjusters, employers, patients, and attorneys.
• Skills in data analysis and process improvement.
• Strong organizational skills to manage multiple tasks.
• Leadership qualities with an understanding of supervisory principles.
• Position may require COVID-19 vaccination as per law.
• Active RN licensure in good standing in the home state.
• Must meet specific requirements to provide medical case management services.
• Having at least one national certification (CCM, CDMS, CRRN, COHN) is preferred; if not, plan to obtain within 36 months.
• Certification is necessary for advancement to Senior Medical Case Management.
• Travel may constitute approximately 70% of work time.
• Valid driver's license required.

#LI-KE1

• Review case records, analyze data, evaluate medical status, and identify needs and obstacles to medical resolution and return-to-work (RTW).
• Provide opinions on case costs, treatment plans, outcomes, and make recommendations to meet case management goals, including RTW.
• Meet administrative standards for productivity, time management, and QA with minimal supervision.
• Perform job site evaluations as needed.
• Facilitate timely RTW by establishing professional relationships with injured workers, physicians, and employers, and coordinate RTW efforts.
• Maintain communication with claims adjusters and other involved parties.
• Obtain and review medical records, and coordinate with physicians for reviews and IMEs.
• Utilize clinical expertise to interpret medical information and provide assessments.
• Travel approximately 70% of the time to various locations to support case resolution.
• Meet monthly productivity and QA standards.
• Review cases with supervisors regularly.
• Uphold company standards and demonstrate excellent customer service and professionalism.
• Approach problem-solving independently using available resources.
• Perform other duties as assigned.