Medical Case Manager- Los Angeles County, CA

Crawford & Company•CA, CA

2d•$26 - $47•Remote

About The Position

Crawford & Company is hiring a Medical Case Manager to provide medical case management services in Los Angeles County and surrounding communities. The position is remote with local field travel; travel may account for approximately 70% of work time. The role supports patients and employees receiving benefits through Workers’ Compensation, Group Health, Liability, Disability, and Care Management programs. Case management services are provided in a cost-effective manner consistent with URAC standards, CMSA Standards of Practice, and Broadspire QA Guidelines. The Medical Case Manager evaluates medical status, identifies needs and barriers to case resolution and return to work, coordinates among injured or disabled individuals, physicians, employers, and claims adjusters, and helps facilitate timely return-to-work plans. The role also manages documentation, productivity and quality requirements, and works with supervisors to review cases. Crawford describes the position as an opportunity to grow professionally and contribute to restoring the lives of people and communities. The role requires an associate’s degree or relevant nursing coursework/certification, an active unrestricted RN license, and at least 1–3 years of diverse clinical experience. National case management certification is preferred; if not already obtained, the candidate must plan to take an exam within 36 months. A valid driver’s license is required. The company offers competitive base pay, potential performance-based rewards, a benefits package for eligible full-time employees, training and career progression programs, and community sustainability programs.

Requirements

Associate’s degree or relevant nursing coursework/certification is required; a BSN is preferred.
At least 1–3 years of diverse clinical experience.
An active RN license in good standing, without restrictions, in the candidate’s home state is required.
Must comply with state requirements regarding national certifications and meet requirements to provide medical case management services.
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.
Strong analytical and customer service skills to help 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 proven ability to manage 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 be able to travel; travel may entail approximately 70% of work time.

Nice To Haves

National case management certification, such as CCM, CDMS, CRRN, or COHN; certification from a URAC-approved list is preferred.
Workers’ compensation case management experience.
BSN degree.
If not already certified, plan to take a national certification exam within 36 months; national certification is required to reach Senior Medical Case Management status.

Responsibilities

Review case records and reports; collect and analyze data; evaluate the medical status of injured workers or disabled individuals; 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; recommend actions to support case management goals, including return to work.
Meet administrative requirements for productivity, time management, and quality assurance with minimal supervisory intervention.
May perform job-site evaluations and prepare summaries to facilitate case management.
Establish professional working relationships with injured workers or disabled individuals, physicians, and employers; coordinate return-to-work plans and facilitate timely return-to-work dates.
Maintain contact with claims adjusters to report case activity and direction or obtain service authorization; communicate with other parties involved in case management as needed.
May obtain records from the branch claims office and review files for claims adjusters and supervisors to determine whether case management referrals are appropriate.
May meet with employers to review active files.
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 as needed to homes, healthcare providers, job sites, and offices to facilitate return to work and case resolution; travel may comprise approximately 70% of work time.
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.
Independently solve problems 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 at no cost.
Virtual physical therapy at no cost.
Caregiving services at no cost.
Life Assistance Program at no cost.
Free continuing education units for licenses and certificates.
License and certification reimbursement.
Training programs supporting continuous learning and career progression.