Medical Case Manager- Palm Desert / Coachella Valley, CA

Crawford & Company•CA, CA

5d•$26 - $47•Remote

About The Position

Crawford & Company is hiring a part-time Registered Nurse Case Manager based in or near Palm Desert, Palm Springs, Indio, or Coachella, California. The role is remote with local field travel, which may account for approximately 70% of working time. The case manager provides cost-effective medical case management consistent with URAC standards, CMSA Standards of Practice, and Crawford’s QA Guidelines. Cases may involve Workers’ Compensation, Group Health, Liability, Disability, and Care Management benefits. The position focuses on evaluating medical status, identifying needs and obstacles to case resolution, coordinating care and return-to-work plans, and communicating with the injured or disabled individual, physicians, employers, claims adjusters, and other parties. Compensation is described as competitive and commensurate with experience, with quarterly bonus opportunities. The posting also mentions free CEUs and reimbursement for licenses and certifications.

Requirements

Associate’s degree or relevant nursing coursework or certification is required; a BSN is preferred.
Minimum of 1–3 years of diverse clinical experience and either a registered nurse license or a case-manager certification from the URAC-approved list; the posting also states that certification is preferred.
Active, unrestricted RN licensure in good standing in the nurse’s home state, and compliance with state requirements concerning 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 to facilitate return-to-work solutions in a matrix organization and ensure timely, quality documentation.
Excellent 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.
Excellent organizational skills and proven ability to handle multiple tasks simultaneously.
Demonstrated leadership ability and basic understanding of supervisory and management principles.
Ability to meet specific requirements for providing medical case management services.
Valid driver’s license in state of residence.
Ability to travel, which may entail approximately 70% of work time.

Nice To Haves

BSN degree.
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 ensuing 36 months. National certification is required to reach Senior Medical Case Management status.
Workers’ compensation case management experience.

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 proactive case management services and 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 the case management process.
Build professional working relationships with injured or disabled individuals, physicians, and employers; coordinate return-to-work plans and facilitate timely return-to-work dates.
Maintain contact with claims adjusters to communicate case activity and direction or obtain authorization for services, and stay in contact with other parties as necessary for case management.
Obtain records from the branch claims office when needed.
Review files for claims adjusters and supervisors to identify appropriate referrals for case management services 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 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 working time.
Meet monthly production and quality-assessment requirements.
Review cases with a supervisor monthly to evaluate files and obtain 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.