Medical Case Manager

Description RN Case Manager – Colorado Springs, CO Region 💻 Remote position + local field travel 💰 Salary: Competitive & commensurate with experience 🎉 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 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! Responsibilities - 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. Qualifications - Associate's degree or relevant course work/certification in Nursing is required; BSN Degree is preferred. - Minimum of 1-3 years diverse clinical experience and one of the below: - Certification as a case manager from the URAC-approved list of certifications (preferred); - A registered nurse (RN) license. - Must be compliant with state requirements regarding national certifications. - General working knowledge of case management practices and ability to quickly learn and apply workers compensation/case management products and services. - Excellent oral and written communications skills to effectively facilitate return-to-work solutions within a matrix organization and ensure timely, quality documentation. - Excellent