Overview Medical Case Manager- CA role at Crawford & Company. This is a work-from-home position requiring local field case management travel to cover the San Jose, California region.
Salary details: $51,283 - $93,781 annually. RN degree required. National certification such as CCM, CRC, COHN, CRRC preferred. Travel may entail approximately 70% of work time. Must maintain a valid driver’s license in state of residence.
Responsibilities Reviews case records and reports, collects and analyzes data, evaluates medical status of injured workers or disabled individuals, identifies needs and obstacles to case resolution and return to work (RTW).
Render opinions regarding case costs, treatment plans, outcomes and problem areas; make recommendations to facilitate RTW and case management goals.
Meet administrative requirements including productivity, time management and QA standards with minimal supervisory intervention.
May perform job site evaluations or summaries to facilitate the case management process.
Facilitate timely RTW by coordinating with injured workers, physicians and employers; communicate with claims adjusters and all case stakeholders.
Obtain medical records, review files for appropriate referrals, and coordinate referrals for peer reviews and IMEs.
Interpret medical records and test results using clinical expertise to inform assessments.
Travel to homes, health care providers, job sites and offices as required to facilitate RTW and case resolution (approximately 70% travel).
Meet monthly production and QA requirements and review cases with supervisors to obtain directions.
Uphold Crawford & Company Code of Business Conduct and demonstrate excellent customer service and professional collaboration.
Perform other related duties as assigned.
Qualifications Associate’s degree or relevant nursing coursework/certification; BSN preferred.
Minimum 1-3 years of diverse clinical experience.
URAC-approved case manager certification (preferred) or RN license; compliance with state requirements for national certifications.
Working knowledge of case management practices and ability to learn workers’ compensation/case management products and services.
Excellent oral and written communication skills; ability to facilitate RTW solutions within a matrix organization and document effectively.
Strong analytical and customer service skills; basic computer skills including Microsoft Office.
Ability to establish collaborative relationships with claims adjusters, employers, patients, attorneys and all levels of staff; ability to gather and analyze data to improve trends and outcomes.
Strong organizational skills and demonstrated leadership potential; ability to manage multiple tasks.
Active RN license in good standing; willingness to obtain additional national certifications as needed within 36 months to reach Senior Medical Case Manager status.
Travel requirement approximately 70% of work time; valid driver's license required.
About Us Crawford & Company participates in E-Verify and is an Equal Opportunity Employer. We encourage applicants from all backgrounds. Details on benefits, compensation and career growth are provided to employees as part of the onboarding process.