Telephonic Case Manager

Crawford & Company; Peachtree Corners (GA); Remote; USD 60,000 - 80,000; Full time

Job summary

A leading company is seeking a telephonic case manager to provide effective case management services. This work-from-home position involves analyzing case records, facilitating return-to-work solutions, and ensuring compliance with industry standards. Ideal candidates will have an associate's degree in nursing, clinical experience, and strong communication skills.

Benefits

Great Work Life Balance!

Quarterly Bonus Program!

Free CEU's for licenses and certificates

License and national certification reimbursement

Qualifications

• 1-3 years of diverse clinical experience.
• Active RN licensure in good standing.
• Minimum of one national certification (CCM, CDMS, CRRN, COHN).

Responsibilities

• Review case records and analyze data for medical case resolution.
• Facilitate timely return-to-work solutions.
• Maintain communication with claims adjusters and other parties.

Skills

Communication

Analytical Skills

Customer Service

Organizational Skills

Education

Associate's degree in Nursing

BSN preferred

Tools

Microsoft Office

Lotus Notes

Job description

Job Description

• Great Work Life Balance!

• Quarterly Bonus Program!

• Free CEU's for licenses and certificates

• License and national certification reimbursement

This is a work from home telephonic case management position with no travel involved. The role involves 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, including Workers' Compensation, Group Health, Liability, Disability, and Care Management.

• Qualifications:
• Associate's degree or relevant coursework/certification in Nursing; BSN preferred.
• 1-3 years of diverse clinical experience.
• Certification as a case manager from the URAC-approved list (preferred) or a registered nurse (RN) license.
• Must comply with state requirements regarding national certifications.
• Knowledge of case management practices and ability to quickly learn workers' compensation/case management products and services.
• Excellent communication skills for facilitating return-to-work solutions and ensuring quality documentation.
• Strong analytical, customer service, and organizational skills.
• Basic computer skills, including Microsoft Office and Lotus Notes.
• Ability to establish collaborative relationships with claims adjusters, employers, patients, attorneys, and employees.
• Capacity to analyze data and develop improvement plans.
• Leadership abilities with a basic understanding of supervisory principles.
• Active RN licensure in good standing; willingness to meet specific service requirements.
• Minimum of one national certification (CCM, CDMS, CRRN, COHN); if not, plan to obtain within 36 months.
• Travel may constitute approximately 70% of work time; valid driver's license required.

Responsibilities

• Review case records, analyze data, evaluate medical status, and identify needs and obstacles to medical case resolution and return-to-work (RTW).
• Provide opinions on case costs, treatment plans, and outcomes; make recommendations to achieve case management goals.
• Meet administrative standards for productivity, time management, and QA with minimal supervision.
• Perform job site evaluations and summaries as needed.
• Facilitate timely RTW by building professional relationships with injured workers, employers, and physicians.
• Maintain communication with claims adjusters and other involved parties to ensure case progress.
• Obtain and review medical records, coordinate referrals for peer reviews and IMEs, and interpret medical information.
• Travel to homes, healthcare providers, and job sites to support case management activities.
• Meet monthly production and QA requirements, review cases with supervisors, and uphold company standards and code of conduct.
• Demonstrate excellent customer service, problem-solving skills, and the ability to work independently.
• Perform additional duties as assigned.