Telephonic Medical Case Manager

Crawford & Company; California (MO); Remote; USD 50,000 - 80,000; Full time

Job summary

An established industry player is seeking a Telephonic Medical Case Manager for a work-from-home opportunity. In this role, you'll provide proactive case management services, ensuring effective communication with all stakeholders. With a focus on restoring lives and communities, this position offers a chance to make a meaningful impact while enjoying the flexibility of remote work. Join a collaborative culture that values growth and innovation, and take your career to new heights in a supportive environment.

Benefits

Free CEUs for licenses and certificates

License reimbursement

National certification reimbursement

Flexible work-from-home option

Qualifications

• RN and Compact licensure are required for this role.
• 1-3 years of clinical experience is preferred.

Responsibilities

• Provide effective case management services adhering to various standards.
• Review case records, analyze data, and evaluate medical status.

Skills

Case Management

Communication Skills

Analytical Skills

Organizational Skills

Clinical Experience

Education

Associate's Degree

Bachelor of Science in Nursing (BSN)

Job description

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• 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 and Compact licensure are required
• National Certification (ex: CCM, COHN, CRRN) are preferred
• Worker's Compensation experience preferred

Job Description

• Provide effective case management services in an appropriate, cost-effective manner, adhering to URAC standards, CMSA Standards of Practice, and Broadspire QA Guidelines for various insurance lines including Workers' Compensation, Group Health, Liability, Disability, and Care Management.

Responsibilities

• Review case records, analyze data, evaluate medical status, and identify needs and obstacles to medical case resolution and RTW by providing proactive case management services.
• Provide opinions on case costs, treatment plans, and outcomes, and make recommendations to facilitate case management goals including RTW.
• Meet administrative requirements such as productivity, time management, and QA standards with minimal supervision.
• Perform job site evaluations to facilitate case management.
• Establish professional relationships to facilitate timely RTW, coordinating with injured workers, employers, and physicians.
• Maintain communication with claims adjusters, physicians, and other parties involved.
• Review files, make referrals for peer reviews and IMEs, and interpret medical records and test results.
• Travel approximately 70% of the time to homes, healthcare providers, job sites, and offices.
• Meet monthly production and QA requirements, review cases with supervisors, and uphold company standards and customer service excellence.

Qualifications

• Associate's degree or relevant nursing coursework; BSN preferred.
• 1-3 years of clinical experience.
• URAC-certified case manager or RN license required.
• Knowledge of case management practices and workers' compensation services.
• Excellent communication, analytical, organizational, and computer skills.
• Ability to establish collaborative relationships and analyze data for process improvement.
• Active RN license in good standing and willingness to obtain national certification if not already held.
• Must be able to travel up to 70% and hold a valid driver's license.
• Based on law, may require COVID-19 vaccination.

About Us

Why Crawford? Because a claim is more than a number — it’s a person. We help restore lives and communities, fostering a culture of growth, innovation, and inclusion. Learn more at www.crawco.com.

Our total compensation includes performance-based pay, benefits, continuous learning opportunities, community programs, and a respectful, collaborative culture.

Crawford & Company participates in E-Verify and is an Equal Opportunity Employer.