Telephonic Medical Case Manager

Crawford & Company in; Peachtree Corners (GA); Remote; USD 60,000 - 90,000; Full time

Job summary

An innovative company is seeking a Telephonic Medical Case Manager to provide exceptional case management services from the comfort of your home. This role emphasizes a great work-life balance and offers a quarterly bonus program, along with reimbursement for licenses and certifications. The ideal candidate will possess RN licensure and have a passion for helping others navigate their healthcare journey. Join a team that values collaboration and efficiency, where your expertise will make a significant impact on patients' lives and outcomes. If you're ready to take the next step in your career, this opportunity awaits you!

Benefits

Great Work Life Balance

Quarterly Bonus Program

Free CEUs for licenses and certificates

License and national certification reimbursement

Qualifications

• RN and Compact licensure are required for this position.
• National Certification in case management is preferred.

Responsibilities

• Provide effective case management services adhering to URAC standards.
• Review case records, analyze data, and facilitate case resolution.
• Establish relationships with claims adjusters, employers, and patients.

Skills

Case Management

RN Licensure

Communication Skills

Data Analysis

Problem-Solving

Education

Registered Nurse (RN)

National Certification (CCM, COHN, CRRN)

Job description

Telephonic Medical Case Manager (Finance)

Benefits:

• Great Work Life Balance!
• Quarterly Bonus Program!
• Free CEUs for licenses and certificates
• License and national certification reimbursement

Position Details:

• 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 Responsibilities:

1. Provide effective case management services in an appropriate, cost-effective manner, adhering to URAC standards, CMSA Standards of Practice, and Broadspire QA Guidelines for patients/employees receiving benefits under various insurance lines.
2. Review case records, analyze data, evaluate medical status, identify needs and obstacles, and facilitate case resolution and return-to-work (RTW).
3. Render opinions on case costs, treatment plans, outcomes, and problem areas, making recommendations to achieve case management goals including RTW.
4. Establish collaborative relationships with claims adjusters, employers, patients, attorneys, and staff.
5. Gather and analyze data to improve trends, processes, and outcomes.
6. Maintain organizational efficiency by handling multiple tasks and meeting productivity standards.
7. Possibly perform job site evaluations and summaries.
8. Coordinate RTW efforts by establishing professional relationships with injured workers, physicians, and employers.
9. Communicate regularly with claims adjusters and other involved parties to update case status and secure necessary authorizations.
10. Review files, obtain records, and facilitate referrals for peer reviews and IMEs.
11. Utilize clinical expertise to interpret medical records and test results, providing assessments accordingly.
12. Travel approximately 70% of work time to homes, healthcare providers, job sites, and offices as needed.
13. Meet monthly production and QA standards.
14. Review cases with supervisors and uphold company policies and standards.
15. Demonstrate excellent customer service and problem-solving skills.
16. Perform other duties as assigned.