Sr Medical Case Manager-CA

Crawford & Company • Los Angeles, CA

125d • Remote

About The Position

This is a work from home position requiring local field case management travel to cover the Los Angeles, California region. The role involves providing quality case management services in an appropriate, cost-effective manner. The case manager will provide medical case management service consistent with URAC standards and CMSA Standards of Practice and Quality Improvement Guidelines to patients/employees receiving benefits under an Insurance Line including but not limited to Workers' Compensation, Group Health, Liability, and Disability.

Requirements

• RN degree required.
• Active RN home state licensure in good standing without restrictions.
• Minimum of 1 nationally recognized Certification from the URAC list of approved certifications.
• Three years of Workers' Compensation case management experience.
• Demonstrated ability to handle complex assignments and work independently.
• Effective oral and written communication skills.
• Thorough understanding of jurisdictional WC statutes.
• Advanced knowledge to exert positive influence in all areas of case management.

Nice To Haves

• Bachelor's Degree in a health-related field is preferred.
• Associates or diploma in nursing also accepted.
• Experience in catastrophic cases plus 2-3 additional types of service.

Responsibilities

• Provide quality case management services in an appropriate, cost-effective manner.
• Deliver medical case management service consistent with URAC standards and CMSA Standards of Practice.
• Coordinate a diverse caseload ranging in moderate to high complexity.
• Conduct training, provide mentorship, and assist supervisor in general areas as assigned.
• Facilitate a timely return to work date by establishing a professional working relationship with the client, physician, and employer.
• Prepare monthly written evaluation reports denoting case activity, progress, and recommendations.
• Maintain contact and communicate with insurance adjusters to apprise them of case activity.
• Travel approximately 70% of work time to homes, health care providers, job sites, and various offices.

Benefits

• Great Work Life Balance!
• Quarterly Bonus Opportunities!
• Free CEU's for licenses and certificates.
• License and national certification reimbursement.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Industry: Insurance Carriers and Related Activities
• Education Level: Bachelor's degree