Medical Case Manager

Crawford & Company - Orlando, FL

Full-time - Mid Level

Remote - Orlando, FL

Insurance Carriers and Related Activities

About the position

The Medical Case Manager at Crawford & Company is responsible for providing effective case management services to patients and employees receiving benefits under various insurance lines, including Workers' Compensation. This role requires a combination of clinical expertise, strong communication skills, and the ability to manage cases proactively to facilitate timely return-to-work solutions. The position offers a work-life balance with opportunities for continuing education and a monthly bonus program, while primarily being a work-from-home role with local travel requirements.

Responsibilities

• Review case records and reports, collect and analyze data, and evaluate the medical status of injured workers or disabled individuals.
• Identify needs and obstacles to medical case resolution and return to work (RTW) by providing proactive case management services.
• 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.
• Facilitate timely return to work dates by establishing professional relationships with injured workers, physicians, and employers.
• Coordinate RTW efforts with injured workers, employers, and physicians.
• Maintain communication with claims adjusters regarding case activity and direction.
• Obtain and review medical records and diagnostic films for peer reviews and independent medical evaluations (IMEs).
• Utilize clinical expertise to interpret medical records and test results, providing assessments accordingly.
• Meet monthly production and quality assessment requirements to ensure a quality product.

Requirements

• Associate's degree or relevant coursework/certification in Nursing is required; BSN Degree is preferred.
• Minimum of 1-3 years of diverse clinical experience.
• Certification as a case manager from the URAC-approved list of certifications (preferred) or a registered nurse (RN) license.
• Active RN home state licensure in good standing without restrictions.
• Minimum of 1 National Certification (CCM, CDMS, CRRN, COHN) is preferred, with a plan to take the certification exam within 36 months if not attained.
• General working knowledge of case management practices and ability to learn workers' compensation/case management products and services quickly.
• Excellent oral and written communication skills.
• Excellent analytical and customer service skills.
• Basic computer skills including working knowledge of Microsoft Office products.

Nice-to-haves

• Leadership experience
• Certified Disability Management Specialist
• Certified Case Manager (CCM)
• Certified Rehabilitation Registered Nurse (CRRN)
• Occupational Health Nurse (COHN)

Benefits

• Continuing education credits
• License reimbursement
• Monthly bonus program
• Free CEUs for licenses and certificates
• License and national certification reimbursement