Medical Case Manager- CA

Overview

Job Title:

Case Manager, Registered Nurse - Fully Remote

Location:

Sacramento, CA region (work from home with local field travel)

Salary:
Sacramento, CA $54,095.00-$;
Citrus Heights, CA $22.00-$25.00 (as listed)

Note:

This is a work from home position requiring local field case management travel to cover the Sacramento, California region.

• Provide effective medical case management services in accordance with URAC standards, CMSA Standards of Practice, and Broadspire QA Guidelines for patients/employees receiving benefits under an Insurance Line (including Workers’ Compensation, Group Health, Liability, Disability, and Care Management).
• Review case records and reports, collect and analyze data, evaluate medical status, identify needs and obstacles to resolution and return-to-work (RTW) through proactive case management.
• Render opinions on case costs, treatment plans, outcomes, and problem areas; make recommendations to facilitate RTW goals.
• Meet administrative requirements (productivity, time management, QA) with minimal supervisory intervention.
• May perform job site evaluations to facilitate the case management process.
• Establish and maintain professional relationships with injured workers/disabled individuals, physicians, and employers to facilitate RTW; coordinate RTW activities among all parties.
• Maintain contact with claims adjusters and other stakeholders; obtain and review records as needed; refer cases for peer reviews and IMEs as appropriate.
• Utilize clinical expertise to interpret medical records and test results and provide assessments accordingly.
• Travel up to approximately 70% of work time to homes, health care providers, job sites, and offices to facilitate RTW and case resolution.
• Meet monthly production and QA requirements and review cases with supervisors to obtain direction.
• Uphold the Crawford and Company Code of Business Conduct and demonstrate excellent customer service and professionalism.
• May perform other related duties as assigned.

• Associate’s degree or relevant coursework/certification in Nursing required; BSN preferred.
• Minimum of 1-3 years of diverse clinical experience.
• RN license in good standing; active state licensure required.
• National certification preferred (e.g., CCM, CDMS, CRRN, COHN); if not held, plan to take certification exam within 36 months.
• URAC-approved case management certification is preferred.
• General knowledge of case management practices and ability to quickly learn workers’ compensation products and services.
• Excellent oral and written communication skills to facilitate RTW solutions and ensure timely, quality documentation.
• Strong analytical, organizational, and customer service skills; ability to manage multiple tasks simultaneously.
• Basic computer skills, including Microsoft Office; ability to work within a matrix organization.
• Ability to establish collaborative relationships with claims adjusters, employers, patients, attorneys, and staff.
• Must be able to travel and maintain a valid driver’s license in the state of residence.
• COVID-19 vaccination may be required based on federal, state, or local law.

Why Crawford? Because a claim is more than a number — it’s a person. Crawford & Company is an Equal Opportunity Employer. We are committed to an inclusive environment for all employees and applicants.

Our total compensation plan includes pay and incentive programs, benefit programs supporting 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. 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 email or in any form without a valid written Statement of Work in place will be treated as the property of Crawford.

No fee will be paid in the event the candidate is hired through other means.

• Seniority level:
  Entry level
• Employment type:
  
  Full-time
• Job function:
  Health Care Provider
• Industries:
  Insurance