Medical Case Manager

Position Overview

Now Hiring: RN Case Manager - Louisville, KY Region. Location: Louisville, KY Region. Salary: Competitive & commensurate with experience. Schedule: Work from home with local field travel. This position offers quarterly bonus opportunities, free CEUs for licenses & certificates, and license & certification reimbursement. Join our team to provide effective case management services in a cost-effective manner in alignment with URAC, CMSA, and Broadspire QA guidelines, and help restore our community one claim at a time.

Key Responsibilities

• Review case records and reports; collect and analyze data to evaluate medical status and identify needs for effective case resolution.
• Render opinions regarding case costs, treatment plans, outcomes, and provide recommendations to achieve case management goals.
• Meet administrative requirements including productivity, time management, and quality assurance standards.
• Conduct job site evaluations and summaries to support the case management process.
• Facilitate timely return-to-work by coordinating with injured workers, physicians, employers, and claims adjusters.
• Maintain continuous communication with all parties involved to ensure effective case progress.
• Obtain necessary records and review files to support referrals for case management services.
• Coordinate referrals for peer reviews and independent medical examinations by obtaining and delivering required documentation.
• Utilize clinical expertise to interpret medical records and test results, providing accurate assessments.
• Travel as required (approximately 70% of work time) to homes, healthcare providers, job sites, and various offices.
• Achieve monthly production and quality assessment targets while regularly reviewing cases with supervisors.
• Uphold the Crawford and Company Code of Business Conduct while delivering exceptional customer service.
• Independently problem-solve using available research and resources.
• Perform other related duties as assigned.

Required Qualifications

• RN degree required; Associate's degree or relevant coursework/certification in Nursing is required.
• Requirements: Active RN licensure in good standing and compliance with state requirements.
• Minimum of 1-3 years of diverse clinical experience.
• General working knowledge of case management practices with the ability to quickly learn workers' compensation and related services.
• Excellent oral and written communication, analytical, and customer service skills.
• Basic computer skills, including proficiency in Microsoft Office and Lotus Notes.
• Proven ability to handle multiple tasks simultaneously and establish collaborative working relationships.
• Demonstrated leadership ability along with a basic understanding of supervisory and management principles.
• Must maintain a valid driver's license in the state of residence.

Preferred Qualifications

• BSN Degree is preferred.
• National Certification (e.g., CCM, CRC, COHN, CRRC, CDMS, CRRN) is preferred, or a plan to obtain certification within 36 months.
• Workers' Compensation Case Management experience is a plus.
• Certification as a case manager from the URAC-approved list is preferred.

Benefits & Perks

• Benefits: Quarterly Bonus Opportunities.
• Benefits: Free CEUs for licenses & certificates.
• Benefits: License & Certification Reimbursement.
• Additional perks include a competitive total compensation package, comprehensive benefit programs, professional training and career development initiatives, sustainability programs, and a collaborative, inclusive company culture.