Sr Medical Case Manager

Crawford & Company; Houston (TX); Remote; USD 60,000 - 100,000; Full time

Job summary

An established industry player is seeking a dedicated case manager to provide quality services in a remote work environment. This role requires effective communication and analytical skills to manage cases across various insurance lines, including Workers' Compensation. The ideal candidate will have a strong background in case management, with a focus on delivering proactive solutions while maintaining compliance with industry standards. If you're passionate about making a difference in the lives of clients and enjoy a dynamic work environment, 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; bilingual preferred.
• Three years of Workers' Compensation case management experience preferred.

Responsibilities

• Provide quality case management services adhering to URAC and CMSA standards.
• Manage cases across various insurance lines including Workers' Compensation.

Skills

Case Management

Communication Skills

Analytical Skills

Bilingual Communication

Education

Registered Nurse (RN) Degree

National Certification from URAC

Job description

Job Description

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 field case management travel to cover the Houston, TX region.

Responsibilities

• Provide quality case management services in an appropriate, cost-effective manner, adhering to URAC standards and CMSA Standards of Practice and Quality Improvement Guidelines.
• Manage cases under various insurance lines including Workers' Compensation, Group Health, Liability, and Disability.
• Review case records, analyze data, evaluate client status, and define needs to deliver proactive case management services.
• Coordinate return-to-work processes by establishing professional relationships with injured workers, physicians, and employers.
• Facilitate peer reviews and IMEs by managing medical records and diagnostics.
• Handle cases across multiple product lines, including catastrophic cases, and provide recommendations for treatment and rehabilitation.
• Communicate effectively with insurance adjusters and other parties involved in cases.
• Travel approximately 70% of the time to various locations for case management activities.

Qualifications

• RN degree required; bilingual preferred.
• Active RN license in good standing; minimum one nationally recognized certification from the URAC list.
• Three years of Workers' Compensation case management experience preferred.
• Knowledge of jurisdictional WC statutes and ability to handle complex cases independently.
• Effective communication skills, both oral and written.
• Must be able to travel as required and maintain a valid driver's license.
• Additional qualifications include experience with multiple product lines, ability to work independently, and strong interpersonal skills.