Sr Medical Case Manager

Position

RN Case Manager – Lubbock, TX Region – Work from Home and local field travel. Salary competitive and commensurate with experience. Quarterly bonus opportunities. Free CEUs for licenses and certificates. License and certification reimbursement.

We’re looking for an RN with a passion for case management to join our team. RN degree required. National certification required (CCM, CRC, COHN, CRRN). Workers’ Comp case‑management experience required.

• 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.
• Support patients/employees receiving benefits under insurance lines including Workers’ Compensation, Group Health, Liability, Disability, and Care Management.
• Review case records and reports, collect and analyze data, evaluate client’s medical and vocational status, and define needs and problems to provide proactive case management services.
• Meet or surpass administrative requirements, including productivity, time management, and quality assessment standards with minimal supervisory intervention.
• Facilitate timely return-to-work dates by establishing professional relationships with injured workers, physicians, and employers; coordinate return‑to‑work plans.
• Recommend and facilitate completion of peer reviews and independent medical examinations by obtaining and delivering medical records and diagnostic films.
• Manage cases of at least three to four service areas, including catastrophic cases plus two to three additional types.
• Render opinions regarding case cost, treatment plan, outcome, and problem areas, making recommendations to facilitate rehabilitation case‑management goals to include RTW.
• Review files for claims adjusters and supervisors. Perform job‑site evaluations and prepare monthly written evaluation reports.
• Obtain referrals from branch claims office or assist in phone calls for management as needed.
• Maintain contact and communicate with insurance adjusters and all parties involved in the case for rehabilitation.
• Reserve approximately 70% of work time traveling to homes, healthcare providers, job sites, and offices as required.
• Meet with employers to review active files; review cases with supervisor monthly.
• Uphold the Crawford and Company Code of Business Conduct at all times.
• Demonstrate excellent customer service and respect for customers, co‑workers, and management.
• Approach problem resolution independently using research and resources.
• Perform other related duties as assigned.

• Bachelor’s degree in a health‑related field preferred; associate’s degree or nursing diploma also accepted.
• Three years of Workers’ Compensation case‑management experience, ability to independently coordinate a diverse caseload of moderate to high complexity.
• Demonstrated ability to handle complex assignments and work independently.
• Effective oral and written communication skills.
• Thorough understanding of jurisdictional Workers’ Compensation statutes.
• Advanced knowledge to influence all areas of case management.
• Advanced communication and interpersonal skills for training, mentorship, and supervision assistance.
• High skill in promoting managed care products and services internally and externally.
• Active RN home‑state licensure in good standing, no restrictions with the State Board of Nursing.
• Minimum of one nationally recognized certification from the URAC list of approved certifications.
• Ability to travel as required.
• Valid driver’s license in the state of residence.
• Active professional license or certification permitting practice as a health professional in the U.S. with a relevant scope of practice for initial clinical review.

• Work‑from‑home plus local field travel.
• Competitive salary and quarterly bonus opportunities.
• Free CEUs for licenses and certificates.
• License and certification reimbursement.
• Opportunity for career growth and work‑life balance.