Medical Case Manager PT

Crawford•Overland Park, KS

4d•Remote

About The Position

The Medical Case Manager provides medical case management services for people receiving benefits under Workers’ Compensation, Group Health, Liability, Disability, and Care Management insurance lines. The role evaluates medical status, identifies treatment and return-to-work needs, and helps resolve barriers while following URAC standards, CMSA Standards of Practice, and Broadspire QA Guidelines. The position combines remote work with local field travel and requires residence in Overland Park, Kansas, or a surrounding community within the greater Kansas City metropolitan area. Travel may account for approximately 70% of work time and includes visits to homes, healthcare providers, job sites, and offices. The position requires an active RN license and clinical experience; national case-management certification is preferred, with certification required for advancement to Senior Medical Case Management status.

Requirements

Associate’s degree or relevant coursework or certification in Nursing.
At least 1–3 years of diverse clinical experience.
An active RN license in the home state, in good standing and without restrictions, and compliance with State Board of Nursing requirements.
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 to facilitate return-to-work solutions and provide 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 ability to manage multiple tasks simultaneously.
Demonstrated leadership ability and a basic understanding of supervisory and management principles.
Reside in Overland Park, Kansas, or surrounding communities within the greater Kansas City metropolitan area, within a reasonable driving distance of the service area.
Maintain a valid driver’s license in the state of residence.
Travel may entail approximately 70% of work time.
The position may require full COVID-19 vaccination based on federal, state, or local law.

Nice To Haves

Bachelor of Science in Nursing (BSN).
National case-management certification, such as CCM, CRC, COHN, CRRN, or CDMS. At least one national certification is preferred; if not already obtained, the candidate 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.

Responsibilities

Review case records and reports; collect and analyze data; evaluate medical status; and identify needs and obstacles to medical case resolution and return to work.
Provide proactive case management, assess case costs and treatment plans, identify problem areas, and recommend actions to meet 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 as needed to facilitate case management.
Build professional working relationships with injured workers or disabled individuals, physicians, and employers to facilitate timely return to work.
Coordinate return-to-work plans with injured workers, employers, and physicians.
Communicate with claims adjusters about case activity and direction, and obtain authorization for services when needed.
Maintain contact with parties involved in cases and obtain records from branch claims offices as needed.
Review files for claims adjusters and supervisors to identify appropriate referrals for case-management services, and meet with employers to review active files as 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, healthcare providers, job sites, and offices as required to facilitate return to work and case resolution.
Meet monthly production and quality-assessment requirements.
Review cases with a supervisor monthly to evaluate files and receive direction.
Uphold the Crawford and Company Code of Business Conduct and demonstrate excellent customer service and respect for customers, coworkers, and management.
Use appropriate research and resources to solve problems independently.
Perform other related duties as assigned.