Telephonic Case Manager

Crawford & Company in; Peachtree Corners (GA); Remote; USD 65,000 - 85,000; Full time

Job summary

A leading company is seeking a telephonic RN Case Manager to provide effective case management services. This role requires RN licensure, national certifications, and 1-3 years of clinical experience. The position involves analyzing data, coordinating return-to-work efforts, and maintaining communication with various stakeholders. Strong communication and analytical skills are essential for success in this role.

Benefits

Free CEUs for licenses and certificates

License and national certification reimbursement

Qualifications

• RN licensure in good standing required.
• Minimum of 1-3 years of diverse clinical experience.
• National certification (CCM, CRRN) preferred within 36 months.

Responsibilities

• Provide effective case management services compliant with URAC standards.
• Analyze data, evaluate medical status, and facilitate return-to-work solutions.
• Maintain communication with claims adjusters and coordinate RTW efforts.

Skills

Communication

Analytical skills

Customer service

Organizational skills

Leadership

Education

Associate's degree in Nursing

BSN degree

Tools

Microsoft Office

Lotus Notes

Job description

• Free CEUs for licenses and certificates

• License and national certification reimbursement

• This is a work-from-home telephonic case management position!
• No travel involved!
• RN, compact licensure, and an advanced Nurse Case Management certification (e.g., CCM, COHN, CRRN) are required!

To provide effective case management services in an appropriate, cost-effective manner. Provides medical case management that complies with URAC standards, CMSA Standards of Practice, and Broadspire QA Guidelines to patients/employees receiving benefits under various insurance lines including, but not limited to, Workers' Compensation, Group Health, Liability, Disability, and Care Management.

• An Associate's degree or relevant coursework/certification in Nursing is required; a BSN degree is preferred.
• Minimum of 1-3 years of diverse clinical experience and one of the following:
• Certification as a case manager from the URAC-approved list (preferred);
• Must comply with state requirements regarding national certifications.
• General knowledge of case management practices and ability to quickly learn and apply workers' compensation/case management products and services.
• Excellent oral and written communication skills to facilitate return-to-work solutions within a matrix organization and ensure timely, quality documentation.
• Strong analytical and customer service skills to resolve case management issues.
• Basic computer skills, including proficiency with Microsoft Office and Lotus Notes.
• Ability to establish collaborative relationships with claims adjusters, employers, patients, attorneys, and colleagues.
• Ability to analyze data and develop plans to improve trends, processes, and outcomes.
• Excellent organizational skills with the ability to handle multiple tasks simultaneously.
• Leadership skills with an understanding of supervisory and management principles.
• Based on legal requirements, may need to be fully vaccinated against COVID-19.
• Active RN licensure in good standing in the home state.
• Must meet specific requirements to provide medical case management services.
• Minimum of one national certification (CCM, CDMS, CRRN, COHN) preferred; if not, plan to obtain within 36 months.
• National certification is required for advancement to Senior Medical Case Management.
• Travel may constitute approximately 70% of work time.
• Maintain a valid driver's license in your state of residence.
• Review case records, analyze data, evaluate medical status, identify needs, and provide proactive case management services to facilitate RTW.
• Provide opinions on case costs, treatment plans, outcomes, and problem areas; make recommendations to meet case management goals, including RTW.
• Meet productivity, time management, and QA standards with minimal supervision.
• May perform job site evaluations to support case management.
• Facilitate timely RTW by building professional relationships with injured workers, physicians, and employers; coordinate RTW efforts.
• Maintain communication with claims adjusters regarding case activity and authorization needs.
• Obtain and review medical records and diagnostic images; coordinate with physicians and other healthcare providers.
• Use clinical expertise to interpret medical information and provide assessments.
• Approximately 70% of work time may be spent traveling to homes, healthcare providers, job sites, and offices.
• Meet monthly productivity and QA requirements to ensure quality service.
• Review cases with supervisors regularly for guidance and evaluation.
• Uphold the company's Code of Business Conduct.
• Demonstrate excellent customer service and respect for colleagues and clients.
• Approach problem-solving independently using available resources.
• Perform other duties as assigned.