Medical Case Manager

Crawford & Company•Colorado Springs, CO

2h•$53,709 - $98,213•Remote

About The Position

Crawford is hiring a Registered Nurse Medical Case Manager for the Colorado Springs, Colorado region. The role is remote with local field travel, which may account for approximately 70% of work time. The case manager provides cost-effective medical case management consistent with URAC standards, CMSA Standards of Practice, and Crawford/Broadspire quality guidelines. The work supports people receiving benefits under Workers’ Compensation, Group Health, Liability, Disability, and Care Management insurance lines. The position involves evaluating medical status and case needs, coordinating care and return-to-work plans, collaborating with patients, providers, employers, and claims adjusters, and meeting productivity and quality standards. Compensation is described as competitive and commensurate with experience, with quarterly bonus opportunities. The posting also mentions continuing education and license/certification reimbursement.

Requirements

Associate’s degree or relevant coursework/certification in Nursing is required.
Minimum of 1–3 years of diverse clinical experience.
An active, unrestricted RN license in good standing in the employee’s home state is required; must comply with applicable state requirements regarding national certifications.
Must meet specific requirements to provide medical case management services.
General working knowledge of case management practices and ability to quickly learn and apply workers’ compensation and case management products and services.
Excellent oral and written communication skills to facilitate return-to-work solutions in a matrix organization and ensure timely, quality documentation.
Excellent analytical and customer service skills to help resolve case management problems.
Basic computer skills, including working knowledge of Microsoft Office products and Lotus Notes.
Ability to establish collaborative working relationships with claims adjusters, employers, patients, attorneys, and employees at all levels.
Ability to gather and analyze data and develop plans to improve trends, processes, and outcomes.
Excellent organizational skills and proven ability to handle multiple tasks simultaneously.
Demonstrated leadership ability and basic understanding of supervisory and management principles.
Must maintain a valid driver’s license in the state of residence.
Depending on federal, state, or local law, the position may require full COVID-19 vaccination.

Nice To Haves

Bachelor of Science in Nursing (BSN).
At least one national case management certification, such as CCM, CDMS, CRRN, or COHN; a URAC-approved case manager certification is preferred.
Workers’ compensation case management experience.
If not already certified, willingness to plan to take a national certification exam within the ensuing 36 months. National certification is required to attain Senior Medical Case Management status.

Responsibilities

Review case records and reports; collect and analyze data; evaluate the injured worker’s or disabled individual’s medical status; and identify needs and obstacles to medical case resolution and return to work.
Provide opinions regarding case costs, treatment plans, outcomes, and problem areas, and recommend actions to facilitate case management goals, including return to work.
Meet administrative requirements for productivity, time management, and quality assurance with minimal supervisory intervention.
Perform job-site evaluations or summaries when needed to facilitate case management.
Establish professional working relationships with injured workers or disabled individuals, physicians, and employers, and coordinate timely return-to-work plans.
Communicate with claims adjusters about case activity and direction, and obtain authorization for services when needed; maintain contact with other parties involved in case management.
Obtain records from the branch claims office when needed.
Review files for claims adjusters and supervisors to determine whether case management services are appropriate when needed.
Meet with employers to review active files when needed.
Arrange peer reviews and independent medical examinations by obtaining and delivering medical records and diagnostic films, notifying the injured worker or disabled individual, and conferring with physicians.
Use clinical expertise and medical resources to interpret medical records and test results and provide assessments.
Travel to homes, healthcare providers, job sites, and offices as required to facilitate return to work and case resolution; travel may account for approximately 70% of work time.
Meet monthly production and quality-assessment requirements.
Review cases with a supervisor monthly to evaluate files and obtain direction.
Uphold the Crawford and Company Code of Business Conduct and demonstrate excellent customer service and respect for customers, coworkers, and management.
Approach problem solving independently using appropriate research and resources.
Perform other related duties as assigned.