Medical Case Manager - Part Time

Medical Case Manager – Crawford & Company Provide effective case management services in a cost‑effective manner, ensuring compliance with URAC standards, CMSA Standards of Practice, and Broadspire Quality Assurance (QA) Guidelines. Work with workers’ compensation, group health, liability, disability, and care‑management programs. Responsibilities Review case records, collect and analyze data, evaluate medical status, identify needs and obstacles to resolution and return to work (RTW). Render opinions on case costs, treatment plans, outcomes, and problem areas, and make recommendations to facilitate case‑management goals, including RTW. Meet administrative requirements such as productivity, time management, and QA standards with minimal supervisory intervention. Conduct job site evaluations and summaries to facilitate the process. Coordinate RTW by establishing professional relationships with injured workers, physicians, and employers. Maintain communication with claims adjusters regarding case activity and obtain necessary authorizations. Obtain records from branch claims office and review files for appropriate referral to case‑management services. Meet with employers to review active files. Refer for peer reviews and IMEs by delivering medical records and notifying involved parties. Interpret medical records and test results to provide assessments. Spend approximately 70% of work time traveling to homes, healthcare providers, job sites, and offices as required. Meet monthly production and QA requirements to ensure a quality product. Review cases with supervisor monthly to evaluate files and obtain directions. Uphold the Crawford & Company Code of Business Conduct at all times. Demonstrate excellent customer service, respect for customers, coworkers, and management, and independent problem solving. Perform other related duties as assigned. Qualifications Associate's degree or relevant coursework/certification in nursing; BSN preferred. 1–3 years of diverse clinical experience and one of the following: Certification as a case manager from the URAC‑approved list (preferred). Registered Nurse (RN) license. Compliance with state requirements for national certifications. General knowledge of case‑management practices and ability to learn workers compensation/case‑management products quickly. Excellent oral and written communication skills to facilitate RTW solutions within a matrix organization. Strong analytical and customer service skills to resolve case‑management problems. Basic computer skills, including Microsoft Office and Lotus Notes. Ability to establish collaborative relationships with claims adjusters, employers, patients, attorneys, and all levels of employees. Capability to gather and analyze data and establish improvement plans for trends, processes, and outcomes. Excellent organizational skills and ability to handle multiple tasks simultaneously. Demonstrated leadership ability with an understanding of supervisory and management principles. Must be fully vaccinated for COVID‑19 as required by federal, state, or local law. Active RN home‑state licensure in good standing without restrictions. Meet specific requirements to provide medical case‑management services. One national certification (CCM, CDMS, CRRN, COHN) is preferred; if not attained, plan to take the exam within 36 months. Certification required to reach Senior Medical Case Management status. Travel may entail approximately 70% of work time. Maintain a valid driver’s license in your state of residence. About Us Why Crawford? Because a claim is more than a number – it’s a person, a child, a friend. By helping to restore their lives, we help restore our community, one claim at a time. At Crawford, employees are empowered to grow, emboldened to act, and inspired to innovate. Our industry‑leading team pioneers new solutions for the industries and customers we serve. We hail from more than 70 countries and speak dozens of languages, reflecting the global fabric of the audience we serve. Though our reach is vast, we proudly operate as One Crawford: united in purpose, vision, and values. When you accept a job with Crawford, you become part of the One Crawford family. Our total compensation plans provide each of our employees with far more than a great salary. Benefits Pay and incentive plans that recognize performance excellence. Benefits programs that empower financial, physical, and mental wellness. Training programs that promote continuous learning and career progression. Sustainability programs that give back to the communities in which we live and work. 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. Crawford & Company does not accept unsolicited assistance from search firms for this employment opportunity. All resumes submitted by search firms to any employee at Crawford via e‑mail, the Internet or in any form and/or method without a valid written Statement of Work for this position from Crawford HR/Recruitment will be deemed the sole property of Crawford. No fee will be paid if the candidate is hired by Crawford as a result of the referral or through other means. Seniority Level Entry level Employment Type Full‑time Job Function Health Care Provider Insurance #J-18808-Ljbffr Crawford & Company