Medical Case Manager- South Los Angeles County, CA

Crawford & Company•CA, CA

3d•$26 - $47•Remote

About The Position

The Medical Case Manager provides effective, cost-conscious medical case management in accordance with URAC standards, CMSA Standards of Practice, and Broadspire QA Guidelines. The role supports patients and employees receiving benefits under Workers’ Compensation, Group Health, Liability, Disability, and Care Management insurance lines. This is a remote position with local field travel in South Los Angeles County; travel may account for approximately 70% of work time.

Requirements

Associate’s degree or relevant nursing coursework/certification is required; a BSN is preferred.
At least 1–3 years of diverse clinical experience and either an RN license or a case-management certification from the URAC-approved list.
Active, unrestricted RN home-state license in good standing with the State Board of Nursing.
Comply with state requirements regarding national certifications and meet specific requirements to provide medical case-management services.
A valid driver’s license in the state of residence.
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 RTW solutions in a matrix organization and ensure timely, quality documentation.
Strong 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 ability to handle multiple tasks simultaneously.
Demonstrated leadership ability and basic understanding of supervisory and management principles.
Travel may entail approximately 70% of work time.

Nice To Haves

BSN degree.
Workers’ compensation case-management experience.
National case-management certification, such as CCM, CDMS, CRRN, or COHN; if not already attained, the employee must plan to take a certification exam within the subsequent 36 months. National certification is required to reach Senior Medical Case Management status.

Responsibilities

Review case records and reports; collect and analyze data; evaluate injured workers’ or disabled individuals’ medical status; identify needs and obstacles to medical case resolution and return to work (RTW); and provide proactive case management.
Provide opinions regarding case costs, treatment plans, outcomes, and problem areas, and recommend actions that support case management goals, including RTW.
Meet administrative requirements for productivity, time management, and quality assurance (QA), with minimal supervisory intervention.
May conduct job-site evaluations and prepare summaries to facilitate case management.
Build professional working relationships with injured workers or disabled individuals, physicians, and employers; coordinate and facilitate timely RTW.
Maintain contact with claims adjusters to communicate case activity and direction or obtain service authorizations, and communicate with other parties as needed for case management.
May obtain records from the branch claims office, review files for claims adjusters and supervisors for appropriate case-management referrals, and meet with employers to review active files.
Arrange peer reviews and independent medical examinations (IMEs) by obtaining and delivering medical records and diagnostic films, notifying the 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 RTW and case resolution; travel may comprise approximately 70% of work time.
Meet monthly production and QA requirements.
Review cases with a supervisor monthly to evaluate files and receive direction.
Uphold Crawford and Company’s 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.

Benefits

Competitive base pay.
Quarterly bonus opportunities and other performance-based rewards, if applicable.
Medical, dental, and vision plans.
Prescription drug coverage.
HSA, HRA, and FSA accounts.
Paid holidays, vacation, and sick leave.
401(k) retirement plan.
Tuition assistance.
Paid parental leave.
Supplemental health benefits.
Enhanced mental health support at no cost.
Virtual physical therapy at no cost.
Caregiving services at no cost.
Life Assistance Program at no cost.
Free continuing education units (CEUs) for licenses and certificates.
License and certification reimbursement.
Training programs supporting continuous learning and career progression.