Sr. Medical Case Manager

Work from home + local field travel
Salary: $26.65 - $48.74 per hour
Quarterly Bonus Opportunities
Free CEUs for licenses & certificates
License & Certification Reimbursement

We're looking for an RN with a passion for case management to join our team!
RN degree required
National Certification preferred (CCM, CRC, COHN, CRRN)
Workers' Comp Case Management experience a plus

Location Requirement
Candidates must be based in one of these California areas:
San Fernando, Van Nuys, Santa Clarita, Granada Hills, Panorama, Valencia, Oxnard, Westlake Village, Palmdale, or Chatsworth.

Your Impact: You'll provide effective case management services in a cost-effective manner, delivering medical case management consistent with URAC standards, CMSA Standards of Practice, and Broadspire QA Guidelines. You'll support patients/employees receiving benefits under insurance lines including Workers' Compensation, Group Health, Liability, Disability, and Care Management.

This is your chance to grow your career, earn great rewards, and enjoy true work-life balance.

Apply today and make an impact in the community!

• Bachelor's Degree in a health-related field is preferred. Associates or diploma in nursing also accepted.
• Three years of Workers' Compensation case management with ability to independently coordinate a diverse caseload ranging in moderate to high complexity.
• Demonstrated ability to handle complex assignments and ability to work independently is required.
• Effective oral and written communication skills are required.
• Thorough understanding of jurisdictional WC statutes.
• Advanced knowledge to exert positive influence in all areas of case management.
• Advanced communications and interpersonal skills in order to conduct training, provide mentorship, and assist supervisor in general areas as assigned.
• Highly skilled at promoting all managed care products and services internally and externally.
• Active RN home state licensure in good standing without restrictions with the State Board of Nursing.
• Minimum of 1 nationally recognized Certification from the URAC list of approved certifications.
• Must be able to travel as required.
• Individuals who conduct initial clinical review possess an active, professional license or certification:
  • To practice as a health professional in a state or territory of the U.S.; and
  • With a scope of practice that is relevant to the clinical area(s) addressed in the initial clinical review.
• Must maintain a valid driver's license in state of residence.

• 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.