Overview Medical Case Manager role at Crawford & Company. Provides medical case management services consistent with URAC standards, CMSA Standards of Practice, and Broadspire QA Guidelines for patients/employees receiving benefits under Insurance Lines including Workers' Compensation, Group Health, Liability, Disability, and Care Management.
Responsibilities Reviews case records and reports, collects and analyzes data, evaluates medical status, identifies 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; make recommendations to facilitate case management goals including RTW.
Meet administrative requirements, including productivity, time management, and QA standards, with minimal supervisory intervention.
May perform job site evaluations/summaries to facilitate the case management process.
Facilitate timely RTW by establishing professional relationships with the injured worker, physician, and employer; coordinate RTW with all parties.
Maintain contact with claims adjusters and other stakeholders to apprise them of case activity, direction, or authorization for services.
May obtain records from the branch claims office and review files for referrals to case management services.
Meet with employers to review active files as needed.
Make referrals for peer reviews and IMEs by obtaining and delivering medical records and diagnostic films, notifying the injured worker and conferring with physicians.
Utilize clinical expertise to interpret medical records and test results and provide assessments accordingly.
Spends a significant portion of time traveling to homes, health care providers, job sites, and offices to facilitate RTW and case resolution (approximately 70%).
Meet monthly production and QA requirements to ensure quality outcomes; review cases with supervisor monthly.
Uphold Crawford and Company Code of Business Conduct; demonstrate excellent customer service and respect for customers, co-workers, and management.
Independently approaches problem solving using research and available resources; may perform other related duties as assigned.
Qualifications Associate's degree or relevant coursework/certification in Nursing is required; BSN preferred.
1-3 years of diverse clinical experience; certification as a case manager from URAC-approved list preferred or compliance with state certification requirements.
General working knowledge of case management practices and ability to quickly learn workers' compensation/case management products and services.
Excellent oral and written communication skills to facilitate return-to-work solutions within a matrix organization and ensure timely, quality documentation.
Analytical and customer service skills to resolve case management problems.
Basic computer skills including Microsoft Office and Lotus Notes.
Ability to establish collaborative working relationships with claims adjusters, employers, patients, attorneys, and staff; ability to gather and analyze data to improve trends, processes, and outcomes.
Strong organizational skills with the ability to handle multiple tasks simultaneously; demonstrated leadership potential.
COVID-19 vaccination may be required based on federal, state, or local law.
Active RN home state licensure in good standing with the State Board of Nursing.
Minimum of 1 national certification (CCM, CDMS, CRRN, COHN) preferred; if not attained, plan to take certification exam within 36 months.
National certification is required 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.
About Us Why Crawford?
Because a claim is more than a number — it’s a person. At Crawford, we restore lives and communities by helping people on their worst days. We empower growth, action, and innovation across a global team that reflects diverse languages and cultures. Learn more at www.crawco.com. When you join Crawford, you become part of the One Crawford family.
Our total compensation plans include pay and incentive structures, benefit programs for financial, physical, and mental wellness, training and career progression, sustainability programs, and a culture of respect, collaboration, entrepreneurial spirit, and inclusion.
Crawford & Company participates in E-Verify and is an Equal Opportunity Employer. M/F/D/V. All resumes submitted by search firms without a valid Statement of Work will be the property of Crawford. No fee will be paid in the event the candidate is hired through other means.
Job Details Seniority level: Entry level
Employment type: Full-time
Job function: Health Care Provider
Industries: Insurance