Medical Case Manager

Crawford•Colorado Springs, CO

10d•Remote

About The Position

The Medical Case Manager provides effective, cost-conscious medical case management services 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. The position is remote with local field travel in the Colorado Springs, Colorado region, which may account for approximately 70% of work time. The case manager assesses medical status, identifies care and return-to-work barriers, coordinates with injured workers, employers, physicians, claims adjusters, and other parties, and works to facilitate timely return to work and case resolution. The role also involves meeting productivity and quality requirements, maintaining case documentation and communication, and complying with the company’s Code of Business Conduct. Competitive compensation, quarterly bonus opportunities, free continuing education units, and license and certification reimbursement are offered.

Requirements

Associate’s degree or relevant nursing coursework or certification is required.
Minimum of 1–3 years of diverse clinical experience.
Active RN license in good standing without restrictions in the home state, with compliance with applicable State Board of Nursing requirements.
Must meet specific requirements to provide medical case management services.
Must maintain 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 return-to-work solutions within a matrix organization and ensure timely, quality documentation.
Strong analytical and customer service skills to facilitate resolution of 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 establish plans to improve trends, processes, and outcomes.
Excellent organizational skills and ability to handle multiple tasks simultaneously.
Demonstrated leadership ability and a basic understanding of supervisory and management principles.
This position may require full COVID-19 vaccination based on federal, state, or local law.

Nice To Haves

Bachelor of Science in Nursing (BSN) degree preferred.
National case management certification preferred, including CCM, CRC, COHN, CRRN, or CDMS.
Workers’ compensation case management experience is a plus.
If not already certified, must plan to take a national certification exam within the ensuing 36 months; national certification is required to reach Senior Medical Case Management status.

Responsibilities

Review case records and reports, collect and analyze data, evaluate an injured worker’s or disabled individual’s medical status, and identify needs and obstacles to medical case resolution and return to work.
Provide proactive case management services and render opinions regarding case costs, treatment plans, outcomes, and problem areas; make recommendations 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 to facilitate timely return to work.
Coordinate return-to-work activities with injured workers, employers, and physicians.
Maintain contact with claims adjusters to communicate case activity and direction or obtain authorization for services.
Maintain contact with parties involved in a case as needed and obtain records from the branch claims office when required.
Review files for claims adjusters and supervisors to assess whether case management services are appropriate for referral.
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, health care providers, job sites, and offices as needed to facilitate return to work and case resolution; travel may take 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 through appropriate research and use of resources.
Perform other related duties as assigned.