Job details

Medical Case Manager - Hybrid

Responsibilities • Reviews case records and reports, collects and analyzes data, evaluates injured worker/disabled individual's medical status, identifies needs and obstacles to medical case resolution and RTW by providing proactive case management services. • Render opinions regarding case costs, treatment plan, outcome and problem areas, and makes recommendations to facilitate case management goals to include RTW.• Demonstrates ability to meet administrative requirements, including productivity, time management and QA standards, with a minimum of supervisory intervention.• May perform job site evaluations/summaries to facilitate case management process.• Facilitates timely return to work date by establishing a professional working relationship with the injured worker/disabled individual, physician, and employer. Coordinate RTW with injured worker, employer and physicians.• Maintains contact and communicates with claims adjusters to apprise them of case activity, case direction or secure authorization for services. Maintains contact with all parties involved on case, necessary for case management the injured worker/disabled individual.• May obtain records from the branch claims office.• May review files for claims adjusters and supervisors for appropriate referral for case management services.• May meet with employers to review active files.• Makes referrals for Peer reviews and IME's by obtaining and delivering medical records and diagnostic films, notifying injured worker/disabled individual and conferring with physicians.• Utilizes clinical expertise and medical resources to interpret medical records and test results and provides assessment accordingly.• May spend approximately 70% of their work time traveling to homes, health care providers, job sites and various offices as required facilitating RTW and resolution of cases.• Meets monthly production requirements and quality assessment (QA) requirements to ensure a quality product.• Reviews cases with supervisor monthly to evaluate files and obtain directions.• Upholds the Crawford and Company Code of Business Conduct at all times.• Demonstrates excellent customer service, and respect for customers, co-workers, and management.• Independently approaches problem solving by appropriate use of research and resources.• May perform other related duties as assigned.Requirements• Associate's degree or relevant course work/certification in Nursing is required; BSN Degree is preferred.• Minimum of 1-3 years diverse clinical experience and one of the below:• Certification as a case manager from the URAC-approved list of certifications (preferred);• A registered nurse (RN) license.• Must be compliant with state requirements regarding national certifications.• Based on federal, state, or local law, this position may require you to be fully vaccinated for COVID-19.• Active RN home state licensure in good standing without restrictions with the State Board of Nursing.• Must meet specific requirements to provide medical case management services.• Minimum of 1 National Certification (CCM, CDMS, CRRN, and COHN) is preferred. If not attained, must plan to take certification exam within proceeding 36 months.• National certification must be obtained in order to reach Senior Medical Case Management status.• Travel may entail approximately 70% of work time.• Must maintain a valid driver's license in state of residence.• General working knowledge of case management practices and ability to quickly learn and apply workers compensation/case management products and services.• Excellent oral and written communications skills to effectively facilitate return-to-work solutions within a matrix organization and ensure timely, quality documentation.• Excellent analytical and customer service skills to facilitate the resolution of case management problems.• Basic computer skills including working knowledge of Microsoft Office products and Lotus Notes.• Demonstrated ability to establish collaborative working relationships with claims adjusters, employers, patients, attorneys and all levels of employees.• Demonstrated ability to gather and analyze data and establish plans to improve trends, processes, and outcomes.• Excellent organizational skills as evidenced by proven ability to handle multiple tasks simultaneously.• Demonstrated leadership ability with a basic understanding of supervisory and management principles.#J-18808-Ljbffr

Crawford & Company Glassdoor Company Review

3.6

Crawford & Company DE&I Review

No rating

CEO of Crawford & Company

Rohit Verma

Approve of CEO

Average salary estimate

$60000 / YEARLY (est.)

min

max

$50000K

$70000K

If an employer mentions a salary or salary range on their job, we display it as an "Employer Estimate". If a job has no salary data, Rise displays an estimate if available.

What You Should Know About Medical Case Manager - Hybrid, Crawford & Company

Are you a compassionate and results-driven professional looking to make a difference? Join Crawford and Company as a Medical Case Manager in beautiful PA Furnace, PA! As a Medical Case Manager, you'll play a vital role in guiding injured workers and disabled individuals through their journey to recovery. You’ll review case records, analyze key information, and assess the medical needs of your clients to ensure they receive the best treatment possible. Your expertise will help facilitate timely return-to-work solutions by collaborating closely with workers, employers, physicians, and claims adjusters. With an approximate 70% of your time spent traveling, you'll engage directly with those who need assistance most. We value your ability to independently solve problems, and your commitment to exceptional customer service will shine through in every interaction. If you hold an Associate's degree or certification in nursing and have experience in clinical settings, we're eager to see how your skills align with our needs. Come be a part of a team that values integrity and excellence while fostering collaborative relationships to achieve positive outcomes for our clients. Together, we can transform challenging cases into success stories!

Frequently Asked Questions (FAQs) for Medical Case Manager - Hybrid Role at Crawford & Company

What are the primary responsibilities of a Medical Case Manager at Crawford and Company?

As a Medical Case Manager at Crawford and Company, your primary responsibilities include reviewing case records, analyzing medical data, and establishing collaborative relationships to facilitate return-to-work solutions. You'll evaluate injured workers' needs, coordinate with employers and healthcare professionals, and ensure timely communication with claims adjusters. This involves evaluating treatment plans and making recommendations to support successful case management.