Sr Medical Case Manager

Overview

Now Hiring: RN Case Manager - Sioux Falls, SD Region

Work from home + 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, CRRC)
Workers  Comp Case Management experience a plus

Apply today and make an impact in the Sioux Falls community!

• Your impact:
  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.
• May assist supervisor/manager in review of reports, staff development.
• Reviews case records and reports, collects and analyzes data, evaluates client s medical and vocational status and defines needs and problems to provide proactive case management services.
• Demonstrates ability to meet or surpass administrative requirements, including productivity, time management, QA standards with minimal supervisory intervention.
• Facilitates a timely return to work by establishing a professional working relationship with the injured worker/disabled individual, physician and employer. Coordinates return to work with injured worker/disabled individual, employer and physicians.
• May recommend and facilitate completion of peer reviews and IME s by obtaining and delivering medical records and diagnostic films notifying patients.
• Manages cases of various product lines of at least 3-4 areas of service (W/C, Health, STD, LTD, Auto, Liability, TPA, Catastrophic, Life Care Planning). Experienced in catastrophic cases plus 2-3 additional types listed above.
• Renders opinions regarding case cost, treatment plan, outcome, and problem areas; makes recommendations to facilitate rehabilitation case management goals including RTW.
• May review files for claims adjusters and supervisors.
• May perform job site evaluations/summaries. Prepares monthly written evaluation reports denoting case activity, progress and recommendations in accordance with state regulations and company standards.
• May obtain referrals from branch claims office or assist in fielding phone calls for management as needed.
• Maintains contact and communicates with insurance adjusters to apprise them of case activity, case direction or receive authorization for services; maintains contact with all parties involved on case for rehabilitation of the client.
• May spend approximately 70% of work time traveling to homes, health care providers, job sites, and various offices as required to facilitate return to work and resolution of cases.
• May meet with employers to review active files.
• Reviews cases with supervisor monthly to evaluate file and obtain direction.
• 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 resolution by appropriate use of research and resources.
• May perform other related duties as assigned.

• Active RN home state licensure in good standing without restrictions with the State Board of Nursing.
• Minimum of 1 nationally recognized Certification from the URAC list of approved certifications.
• Must be able to travel as required.
• Individuals who conduct initial clinical review possess an active, professional license or certification:
  • To practice as a health professional in a state or territory of the U.S.; and
  • With a scope of practice that is relevant to the clinical area(s) addressed in the initial clinical review.
• Must maintain a valid driver s license in state of residence.