Medical Case Manager- Northern Los Angeles County, CA

Crawford & Company•CA, CA

2d•$26 - $47•Remote

About The Position

Crawford is hiring a Medical Case Manager for Northern Los Angeles County, California. This is a remote position with local field travel; candidates should reside in or near Palmdale, Lancaster, or Bakersfield. The role provides medical case management for individuals receiving benefits through Workers’ Compensation, Group Health, Liability, Disability, and Care Management programs. Services are delivered cost-effectively and in alignment with URAC standards, CMSA Standards of Practice, and Broadspire QA Guidelines. The position involves substantial field travel, which may account for approximately 70% of work time. The Medical Case Manager assesses medical status and case needs, identifies obstacles to medical case resolution and return to work, coordinates with injured workers, employers, physicians, claims adjusters, and other parties, and makes recommendations to advance case goals. The role also requires clinical interpretation of medical records and test results, timely documentation, meeting production and quality standards, and compliance with Crawford’s Code of Business Conduct. An associate’s degree or relevant nursing coursework/certification is required; a BSN and national case management certification are preferred.

Requirements

Associate’s degree or relevant coursework or certification in Nursing.
At least 1–3 years of diverse clinical experience.
A registered nurse (RN) license or a case manager certification from the URAC-approved list.
Active RN home-state licensure in good standing without restrictions with the State Board of Nursing.
Compliance with state requirements regarding national certifications.
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 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 proven ability to handle multiple tasks simultaneously.
Demonstrated leadership ability and a basic understanding of supervisory and management principles.
Must meet specific requirements to provide medical case management services.
Must maintain a valid driver’s license in the state of residence.
Travel may entail approximately 70% of work time.

Nice To Haves

Bachelor of Science in Nursing (BSN).
National certification as a case manager; listed certifications include CCM, CDMS, CRRN, and COHN. If not attained, the employee must plan to take a certification exam within the following 36 months. National certification is required to reach Senior Medical Case Management status.
Workers’ Compensation Case Management experience.
Certification as a case manager from the URAC-approved list.

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 through proactive case management.
Provide opinions regarding case costs, treatment plans, outcomes, and problem areas, and make recommendations to facilitate case management goals, including return to work.
Meet administrative requirements, including productivity, time management, and quality assurance standards, 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 arrangements among them.
Maintain contact and communicate with claims adjusters about case activity and direction, and obtain authorization for services when necessary.
Maintain contact with parties involved in cases as needed for 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.
Refer cases for 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 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.
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.
Virtual physical therapy.
Caregiving services.
Life Assistance Program.
Free continuing education units for licenses and certificates.
License and certification reimbursement.
Training programs that promote continuous learning and career progression.