Medical Case Manager

Crawford & Company - Orlando, FL

Full-time - Entry Level

Remote - Orlando, FL

Insurance Carriers and Related Activities

About the position

The Medical Case Manager is responsible for providing effective case management services to patients and employees receiving benefits under various insurance lines, including Workers' Compensation and Group Health. This role requires a combination of clinical expertise and administrative skills to facilitate timely return-to-work solutions while adhering to industry standards and guidelines. The position offers a work-from-home arrangement with local field travel in the Orlando, Florida region, ensuring a balance between professional responsibilities and personal life.

Responsibilities

• Review case records and reports, collect and analyze data, and evaluate the medical status of injured workers or disabled individuals.
• Render opinions regarding case costs, treatment plans, outcomes, and problem areas, making recommendations to facilitate case management goals.
• Demonstrate the ability to meet administrative requirements, including productivity, time management, and quality assurance standards with minimal supervision.
• Perform job site evaluations and summaries to facilitate the case management process.
• Facilitate timely return-to-work dates by establishing professional relationships with injured workers, physicians, and employers.
• Maintain contact with claims adjusters to update them on case activity and secure authorization for services.
• Obtain records from branch claims offices and review files for appropriate referrals for case management services.
• Meet with employers to review active files and make referrals for peer reviews and independent medical examinations (IMEs).
• Utilize clinical expertise to interpret medical records and test results, providing assessments accordingly.
• Spend approximately 70% of work time traveling to homes, healthcare providers, job sites, and various offices to facilitate return-to-work and case resolution.
• Meet monthly production and quality assessment requirements to ensure a quality product.
• Review cases with supervisors monthly to evaluate files and obtain directions.
• Uphold the Crawford and Company Code of Business Conduct at all times.
• Demonstrate excellent customer service and respect for customers, co-workers, and management.
• Independently approach problem-solving using appropriate research and resources.
• Perform other related duties as assigned.

Requirements

• Associate's degree or relevant coursework/certification in Nursing is required; BSN Degree is preferred.
• Minimum of 1-3 years diverse clinical experience and one of the following: Certification as a case manager from the URAC-approved list of certifications (preferred) or a registered nurse (RN) license.
• Must be compliant with state requirements regarding national certifications.
• 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 the next 36 months.
• 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 communication 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.

Nice-to-haves

• Prior Workers Compensation Case Management experience.

Benefits

• Great Work Life Balance!
• Monthly Bonus Program!
• Free CEUs for licenses and certificates
• License and national certification reimbursement