Telephonic Medical Case Manager

Crawford & Company; Orlando (FL); Remote; USD 65,000 - 85,000; Full time

Job summary

Crawford & Company seeks a Telephonic Nurse Case Manager for a work-from-home position. The role involves providing medical case management services and requires a valid RN license, strong analytical, and communication skills. Join a company that values training, community involvement, and inclusion.

Benefits

Free CEUs for licenses and certificates

License and national certification reimbursement

Comprehensive benefits and performance-based incentives

Qualifications

• Minimum of 1 national certification (e.g., CCM, CRRN) required.
• Active RN licensure in good standing.
• 1-3 years of clinical experience preferred.

Responsibilities

• Provide proactive case management services to facilitate return to work.
• Coordinate with injured workers, physicians, and claims adjusters.
• Maintain productivity and QA standards.

Skills

Communication

Analytical

Organizational

Education

Associate's degree or relevant nursing coursework

BSN preferred

Job description

Job Title: Telephonic Nurse Case Manager

• Free CEU’s for licenses and certificates
• License and national certification reimbursement
• This is a work from home telephonic case management position!
• No Travel involved!
• RN is required!
• Compact licensure and an advanced Nurse case Management certification (e.g., CCM, COHN, CRN) are preferred!

To provide effective case management services in an appropriate, cost-effective manner. Provides medical case management services consistent with URAC standards, CMSA Standards of Practice, and Broadspire Quality Assurance (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.

Responsibilities

1. Review case records and reports, collect and analyze data, evaluate medical status, identify needs and obstacles, and provide proactive case management services to facilitate RTW.
2. Render opinions regarding case costs, treatment plans, outcomes, and problem areas; make recommendations to facilitate case management goals including RTW.
3. Meet administrative requirements, including productivity, time management, and QA standards, with minimal supervision.
4. Perform job site evaluations/summaries as needed.
5. Establish professional relationships with injured workers, physicians, and employers to facilitate timely RTW; coordinate efforts accordingly.
6. Maintain communication with claims adjusters and all parties involved in case management.
7. Obtain medical records and review files for appropriate case management referrals.
8. Meet monthly production and QA requirements to ensure quality service.
9. Review cases with supervisors and uphold company code of conduct.
10. Demonstrate excellent customer service and problem-solving skills.
11. Perform other duties as assigned.

Requirements

• Associate’s degree or relevant nursing coursework; BSN preferred.
• 1-3 years of clinical experience; certification from URAC-approved list preferred.
• Must be compliant with state CPR and licensing requirements.
• Active RN licensure in good standing.
• Minimum of 1 national certification (e.g., CCM, CDMS, CRRN, COHN); plan to obtain within 36 months if not already certified.
• Valid driver’s license.
• Knowledge of case management practices and workers' compensation services.
• Excellent communication, analytical, and organizational skills.
• Proficiency in computer skills including MS Office and Lotus Notes.
• Ability to build collaborative relationships with stakeholders.

Joining Crawford means becoming part of the One Crawford family, offering comprehensive benefits, performance-based incentives, ongoing training, community involvement, and a culture of respect and inclusion.