Medical Case Manager PT

Crawford & Company•Overland Park, KS

5d•$26 - $47•Remote

About The Position

Crawford & Company is hiring a registered nurse to provide medical case management services for individuals receiving benefits under Workers’ Compensation, Group Health, Liability, Disability, and Care Management insurance lines. The role provides case management consistent with URAC standards, CMSA Standards of Practice, and Broadspire QA Guidelines, with the goal of resolving cases and facilitating return to work. It combines remote work with local field travel in the Overland Park, Kansas, and greater Kansas City metropolitan area. Travel may account for approximately 70% of work time and can include visits to homes, healthcare providers, job sites, and offices. The Medical Case Manager reviews records, evaluates medical status, identifies treatment and case-resolution needs, and uses clinical expertise to interpret medical records and test results. The role works collaboratively with injured or disabled individuals, physicians, employers, claims adjusters, and other parties; coordinates return-to-work plans; and maintains timely, quality documentation. The position also involves meeting production and quality standards, reviewing cases with a supervisor monthly, and complying with the Crawford and Company Code of Business Conduct. Candidates need an active, unrestricted RN license in their home state and an associate’s degree or relevant nursing coursework/certification. A BSN and national case-management certification are preferred. If certification has not been attained, the employee must plan to take the exam within 36 months; national certification is required to reach Senior Medical Case Management status. A valid driver’s license is required. Compensation is competitive and commensurate with experience; quarterly bonus opportunities are advertised.

Requirements

Associate’s degree or relevant coursework/certification in nursing is required.
Active RN license in the employee’s home state, in good standing and without restrictions.
One to three years of diverse clinical experience.
Must meet specific requirements to provide medical case-management services and comply with state requirements regarding national certifications.
General working knowledge of case-management practices and ability to learn and apply workers’ compensation and case-management products and services.
Excellent oral and written communication skills, including the ability to facilitate return-to-work solutions and produce timely, quality documentation.
Strong analytical and customer-service skills to 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.
Strong organizational skills and demonstrated ability to handle multiple tasks simultaneously.
Demonstrated leadership ability and a basic understanding of supervisory and management principles.
Must maintain a valid driver’s license in the state of residence.
Must reside in Overland Park, Kansas, or surrounding communities in the greater Kansas City metropolitan area within reasonable driving distance of the service area.
Travel may entail approximately 70% of work time.
The role may require full COVID-19 vaccination based on applicable federal, state, or local law.
If national certification has not been attained, must plan to take a certification exam within the following 36 months; national certification is required to reach Senior Medical Case Management status.

Nice To Haves

BSN degree.
National case-management certification from a URAC-approved list; certifications mentioned include CCM, CRC, COHN, CRRN, and CDMS.
Workers’ compensation case-management experience.

Responsibilities

Review case records and reports, collect and analyze data, evaluate medical status, and identify needs or obstacles to medical case resolution and return to work.
Provide proactive case management and opinions regarding case costs, treatment plans, outcomes, and problem areas; recommend actions to meet case-management goals, including return to work.
Meet administrative, productivity, time-management, and quality-assessment standards with minimal supervisory intervention.
Perform job-site evaluations or summaries when needed to facilitate case management.
Build professional working relationships with injured 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; maintain contact with other parties as required for case management.
Obtain records from the branch claims office when needed.
Review files for claims adjusters and supervisors to determine whether case-management referrals are appropriate.
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 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; 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.