Medical Case Manager- CA

Crawford & Company • Sacramento, CA

108d • Remote

About The Position

This is a work from home position requiring local field case management travel to cover the Sacramento, California region. The role involves providing effective case management services in an appropriate, cost-effective manner. The position requires the provision of medical case management services consistent with URAC standards and CMSA Standards of Practice and Broadspire Quality Assurance (QA) Guidelines to patients/employees receiving benefits under an Insurance Line including but not limited to Workers' Compensation, Group Health, Liability, Disability, and Care Management.

Requirements

• RN degree required.
• Active RN home state licensure in good standing without restrictions with the State Board of Nursing.
• Minimum of 1-3 years diverse clinical experience.
• General working knowledge of case management practices.
• Excellent oral and written communication skills.
• Excellent analytical and customer service skills.
• Basic computer skills including working knowledge of Microsoft Office products and Lotus Notes.
• Demonstrated ability to establish collaborative working relationships.
• Demonstrated ability to gather and analyze data and establish plans to improve trends, processes, and outcomes.
• Excellent organizational skills.

Nice To Haves

• National Certification such as CCM, CRC, COHN, CRRC preferred.
• Certification as a case manager from the URAC-approved list of certifications (preferred).
• BSN Degree preferred.
• Minimum of 1 National Certification (CCM, CDMS, CRRN, and COHN) is preferred.

Responsibilities

• Provide medical case management services consistent with URAC standards and CMSA Standards of Practice.
• Review case records and reports, collect and analyze data, and evaluate injured worker/disabled individual's medical status.
• Identify needs and obstacles to medical case resolution and return-to-work (RTW) by providing proactive case management services.
• Render opinions regarding case costs, treatment plans, outcomes, and problem areas.
• Facilitate timely return to work dates by establishing professional working relationships with injured workers, physicians, and employers.
• Coordinate RTW with injured workers, employers, and physicians.
• Maintain contact and communicate with claims adjusters regarding case activity and direction.
• Perform job site evaluations/summaries to facilitate the case management process.
• Meet monthly production requirements and quality assessment (QA) requirements.
• Uphold the Crawford and Company Code of Business Conduct at all times.

Benefits

• Great Work Life Balance!
• Quarterly Bonus Opportunities!
• Free CEU's for licenses and certificates.
• License and national certification reimbursement.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Industry: Insurance Carriers and Related Activities
• Education Level: Bachelor's degree