Medical Case Manager

To provide effective case management services in an appropriate, cost effective manner.

Provides medical case management service which is consistent with URAC standards and CMSA Standards of Practice and Broadspire Quality Assurance (QA) Guidelines to patients/employees who are receiving benefits under an Insurance Line including but not limited to Workers' Compensation, Group Health, Liability, Disability, and Care Management.


* 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 analytical and customer service skills to facilitate the resolution of case management problems.


* Basic computer skills including working knowledge of Microsoft Office products and Lotus Notes.


* Demonstrated ability to establish collaborative working relationships with claims adjusters, employers, patients, attorneys and all levels of employees.


* Demonstrated ability to gather and analyze data and establish plans to improve trends, processes, and outcomes.


* Excellent organizational skills as evidenced by proven ability to handle multiple tasks simultaneously.


* Demonstrated leadership ability with a basic understanding of supervisory and management principles.


* Based on federal, state, or local law, this position may require you to be fully vaccinated for COVID-19.


* Active RN home state licensure in good standing without restrictions with the State Board of Nursing.


* Must meet specific requirements to provide medical case management services.


* Minimum of 1 National Certification (CCM, CDMS, CRRN, and COHN) is preferred.

If not attained, must plan to take certification exam within proceeding 36 months.


* National certification must be obtained in order to reach Senior Medical Case Management status.


* Travel may entail approximately 70% of work time.


* Must maintain a valid driver's license in state of residence.

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* 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 manag...