Case Manager jobs at The Travelers Companies - 1166 jobs

A leading health care organization located in Minneapolis is seeking an Associate General Counsel to oversee M&A legal functions. The ideal candidate should have a Juris Doctorate, at least 3 years of transactional experience, and strong skills in negotiation and stakeholder management. This position offers a competitive salary range of $132,200 to $226,600 annually along with a comprehensive benefits package. #J-18808-Ljbffr

• Great Work Life Balance! • Quarterly Bonus Opportunities! • Free CEU's for licenses and certificates • License and national certification reimbursement This is a work from home position requiring local field case management travel to cover the Sacramento, California region. RN degree required National Certification such as CCM, CRC, COHN, CRRC preferred Prior Workers Compensation Case Management preferred 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. #LI-KE1 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 management goals to include RTW. Demonstrates ability to meet administrative requirements, including productivity, time management and QA standards, with a minimum of supervisory intervention. May perform job site evaluations/summaries to facilitate case management process. Facilitates timely return to work date by establishing a professional working relationship with the injured worker/disabled individual, physician, and employer. Coordinate RTW with injured worker, employer and physicians. Maintains contact and communicates with claims adjusters to apprise them of case activity, case direction or secure authorization for services. Maintains contact with all parties involved on case, necessary for case management the injured worker/disabled individual. May obtain records from the branch claims office. May review files for claims adjusters and supervisors for appropriate referral for case management services. May meet with employers to review active files. Makes referrals for Peer reviews and IME's by obtaining and delivering medical records and diagnostic films, notifying injured worker/disabled individual and conferring with physicians. Utilizes clinical expertise and medical resources to interpret medical records and test results and provides assessment accordingly. May spend approximately 70% of their work time traveling to homes, health care providers, job sites and various offices as required facilitating RTW and resolution of cases. Meets monthly production requirements and quality assessment (QA) requirements to ensure a quality product. Reviews cases with supervisor monthly to evaluate files and obtain directions. 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 solving by appropriate use of research and resources. May perform other related duties as assigned.

• Great Work Life Balance! • Quarterly Bonus Opportunities! • Free CEU's for licenses and certificates • License and national certification reimbursement This is a work from home position requiring local field case management travel to cover the Los Angeles, California region. RN degree required National Certification such as CCM, CRC, COHN, CRRC required Prior Workers Compensation Case Management preferred To provide quality 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 Quality Improvement Guidelines to patients/employees who are receiving benefits under an Insurance Line including but not limited to Workers' Compensation, Group Health, Liability and Disability. Bachelor's Degree in a health-related field is preferred. Associates or diploma in nursing also accepted. Three years of Workers' Compensation case management with ability to independently coordinate a diverse caseload ranging in moderate to high complexity. Demonstrated ability to handle complex assignments and ability to work independently is required. Effective oral and written communication skills are required. Thorough understanding of jurisdictional WC statutes. Advanced knowledge to exert positive influence in all areas of case management. Advanced communications and interpersonal skills in order to conduct training, provide mentorship, and assist supervisor in general areas as assigned. Highly skilled at promoting all managed care products and services internally and externally. 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. 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. #LI-KE1 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 in order to provide proactive case management services. Demonstrates ability to meet or surpass administrative requirements, including productivity, time management, quality assessment (QA) standards with a minimum of supervisory intervention. Facilitates a timely return to work date by establishing a professional working relationship with the client, physician and employer. Coordinates return to work with patient, 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). Specifically, the case manager should be experienced in catastrophic cases plus 2-3 additional types listed above. Renders opinions regarding case cost, treatment plan, outcome, and problem areas and makes recommendations to facilitate rehabilitation goals and 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, necessary 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 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.

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. #LI-RG1 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 management goals to include RTW. Demonstrates ability to meet administrative requirements, including productivity, time management and QA standards, with a minimum of supervisory intervention. May perform job site evaluations/summaries to facilitate case management process. Facilitates timely return to work date by establishing a professional working relationship with the injured worker/disabled individual, physician, and employer. Coordinate RTW with injured worker, employer and physicians. Maintains contact and communicates with claims adjusters to apprise them of case activity, case direction or secure authorization for services. Maintains contact with all parties involved on case, necessary for case management the injured worker/disabled individual. May obtain records from the branch claims office. May review files for claims adjusters and supervisors for appropriate referral for case management services. May meet with employers to review active files. Makes referrals for Peer reviews and IME's by obtaining and delivering medical records and diagnostic films, notifying injured worker/disabled individual and conferring with physicians. Utilizes clinical expertise and medical resources to interpret medical records and test results and provides assessment accordingly. May spend approximately 70% of their work time traveling to homes, health care providers, job sites and various offices as required facilitating RTW and resolution of cases. Meets monthly production requirements and quality assessment (QA) requirements to ensure a quality product. Reviews cases with supervisor monthly to evaluate files and obtain directions. 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 solving by appropriate use of research and resources. May perform other related duties as assigned.

🚨 Now Hiring: RN Case Manager - San Jose, CA Region 🚨 💻 Work from home + local field travel 💰 Salary: $51,283- $93,781 annually 🎉 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 ✅ Your Impact: You'll 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. You'll support patients/employees receiving benefits under insurance lines including Workers' Compensation, Group Health, Liability, Disability, and Care Management. This is your chance to grow your career, earn great rewards, and enjoy true work-life balance. 👉 Apply today and make an impact in the San Jose community! Responsibilities 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 management goals to include RTW. Demonstrates ability to meet administrative requirements, including productivity, time management and QA standards, with a minimum of supervisory intervention. May perform job site evaluations/summaries to facilitate case management process. Facilitates timely return to work date by establishing a professional working relationship with the injured worker/disabled individual, physician, and employer. Coordinate RTW with injured worker, employer and physicians. Maintains contact and communicates with claims adjusters to apprise them of case activity, case direction or secure authorization for services. Maintains contact with all parties involved on case, necessary for case management the injured worker/disabled individual. May obtain records from the branch claims office. May review files for claims adjusters and supervisors for appropriate referral for case management services. May meet with employers to review active files. Makes referrals for Peer reviews and IME's by obtaining and delivering medical records and diagnostic films, notifying injured worker/disabled individual and conferring with physicians. Utilizes clinical expertise and medical resources to interpret medical records and test results and provides assessment accordingly. May spend approximately 70% of their work time traveling to homes, health care providers, job sites and various offices as required facilitating RTW and resolution of cases. Meets monthly production requirements and quality assessment (QA) requirements to ensure a quality product. Reviews cases with supervisor monthly to evaluate files and obtain directions. 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 solving by appropriate use of research and resources. May perform other related duties as assigned. Qualifications 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. 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. 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. #LI-RG1

Now Hiring: RN Case Manager - Sacramento, CA Region Work from home + local field travel Salary: $52,309 - $95,657 annually 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 Your Impact: You'll 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. You'll support patients/employees receiving benefits under insurance lines including Workers' Compensation, Group Health, Liability, Disability, and Care Management. This is your chance to grow your career, earn great rewards, and enjoy true work-life balance. Apply today and make an impact in the Sacramento community!

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. #LI-RG1 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 management goals to include RTW. Demonstrates ability to meet administrative requirements, including productivity, time management and QA standards, with a minimum of supervisory intervention. May perform job site evaluations/summaries to facilitate case management process. Facilitates timely return to work date by establishing a professional working relationship with the injured worker/disabled individual, physician, and employer. Coordinate RTW with injured worker, employer and physicians. Maintains contact and communicates with claims adjusters to apprise them of case activity, case direction or secure authorization for services. Maintains contact with all parties involved on case, necessary for case management the injured worker/disabled individual. May obtain records from the branch claims office. May review files for claims adjusters and supervisors for appropriate referral for case management services. May meet with employers to review active files. Makes referrals for Peer reviews and IME's by obtaining and delivering medical records and diagnostic films, notifying injured worker/disabled individual and conferring with physicians. Utilizes clinical expertise and medical resources to interpret medical records and test results and provides assessment accordingly. May spend approximately 70% of their work time traveling to homes, health care providers, job sites and various offices as required facilitating RTW and resolution of cases. Meets monthly production requirements and quality assessment (QA) requirements to ensure a quality product. Reviews cases with supervisor monthly to evaluate files and obtain directions. 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 solving by appropriate use of research and resources. May perform other related duties as assigned.

Now Hiring: RN Case Manager - Oklahoma City, OK 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 Location Requirement Candidates must be based in Oklahoma City or cities along the corridor up to Tulsa (including Edmond, Norman, Moore, Stillwater, and surrounding areas) Your Impact: You'll 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. You'll support patients/employees receiving benefits under insurance lines including Workers' Compensation, Group Health, Liability, Disability, and Care Management. This is your chance to grow your career, earn great rewards, and enjoy true work-life balance. Apply today and make an impact in the Oklahoma City community!

Now Hiring: RN Sr Case Manager - Los Angeles, CA Region Work from home + local field travel Salary: $55,450 - $101,393 annually 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 Location Requirement Candidates must be based in one of these California areas: San Fernando, Van Nuys, Santa Clarita, Granada Hills, Panorama, or Valencia. Your Impact: You'll 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. You'll support patients/employees receiving benefits under insurance lines including Workers' Compensation, Group Health, Liability, Disability, and Care Management. This is your chance to grow your career, earn great rewards, and enjoy true work-life balance. Apply today and make an impact in the Los Angeles community!

Now Hiring: RN Case Manager - Indianapolis, IN 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 Your Impact: You'll 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. You'll support patients/employees receiving benefits under insurance lines including Workers' Compensation, Group Health, Liability, Disability, and Care Management. This is your chance to grow your career, earn great rewards, and enjoy true work-life balance. Apply today and make an impact in the Indianapolis community!

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. #LI-RG1 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 management goals to include RTW. Demonstrates ability to meet administrative requirements, including productivity, time management and QA standards, with a minimum of supervisory intervention. May perform job site evaluations/summaries to facilitate case management process. Facilitates timely return to work date by establishing a professional working relationship with the injured worker/disabled individual, physician, and employer. Coordinate RTW with injured worker, employer and physicians. Maintains contact and communicates with claims adjusters to apprise them of case activity, case direction or secure authorization for services. Maintains contact with all parties involved on case, necessary for case management the injured worker/disabled individual. May obtain records from the branch claims office. May review files for claims adjusters and supervisors for appropriate referral for case management services. May meet with employers to review active files. Makes referrals for Peer reviews and IME's by obtaining and delivering medical records and diagnostic films, notifying injured worker/disabled individual and conferring with physicians. Utilizes clinical expertise and medical resources to interpret medical records and test results and provides assessment accordingly. May spend approximately 70% of their work time traveling to homes, health care providers, job sites and various offices as required facilitating RTW and resolution of cases. Meets monthly production requirements and quality assessment (QA) requirements to ensure a quality product. Reviews cases with supervisor monthly to evaluate files and obtain directions. 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 solving by appropriate use of research and resources. May perform other related duties as assigned.

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. #LI-KE1 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 management goals to include RTW. Demonstrates ability to meet administrative requirements, including productivity, time management and QA standards, with a minimum of supervisory intervention. May perform job site evaluations/summaries to facilitate case management process. Facilitates timely return to work date by establishing a professional working relationship with the injured worker/disabled individual, physician, and employer. Coordinate RTW with injured worker, employer and physicians. Maintains contact and communicates with claims adjusters to apprise them of case activity, case direction or secure authorization for services. Maintains contact with all parties involved on case, necessary for case management the injured worker/disabled individual. May obtain records from the branch claims office. May review files for claims adjusters and supervisors for appropriate referral for case management services. May meet with employers to review active files. Makes referrals for Peer reviews and IME's by obtaining and delivering medical records and diagnostic films, notifying injured worker/disabled individual and conferring with physicians. Utilizes clinical expertise and medical resources to interpret medical records and test results and provides assessment accordingly. May spend approximately 70% of their work time traveling to homes, health care providers, job sites and various offices as required facilitating RTW and resolution of cases. Meets monthly production requirements and quality assessment (QA) requirements to ensure a quality product. Reviews cases with supervisor monthly to evaluate files and obtain directions. 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 solving by appropriate use of research and resources. May perform other related duties as assigned.

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. #LI-RG1 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 management goals to include RTW. Demonstrates ability to meet administrative requirements, including productivity, time management and QA standards, with a minimum of supervisory intervention. May perform job site evaluations/summaries to facilitate case management process. Facilitates timely return to work date by establishing a professional working relationship with the injured worker/disabled individual, physician, and employer. Coordinate RTW with injured worker, employer and physicians. Maintains contact and communicates with claims adjusters to apprise them of case activity, case direction or secure authorization for services. Maintains contact with all parties involved on case, necessary for case management the injured worker/disabled individual. May obtain records from the branch claims office. May review files for claims adjusters and supervisors for appropriate referral for case management services. May meet with employers to review active files. Makes referrals for Peer reviews and IME's by obtaining and delivering medical records and diagnostic films, notifying injured worker/disabled individual and conferring with physicians. Utilizes clinical expertise and medical resources to interpret medical records and test results and provides assessment accordingly. May spend approximately 70% of their work time traveling to homes, health care providers, job sites and various offices as required facilitating RTW and resolution of cases. Meets monthly production requirements and quality assessment (QA) requirements to ensure a quality product. Reviews cases with supervisor monthly to evaluate files and obtain directions. 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 solving by appropriate use of research and resources. May perform other related duties as assigned.

Now Hiring: RN Case Manager - Columbia, SC 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 Location Requirement Candidates must be based in one of these South Carolina areas: Greenville, Spartanburg or cities in between the Upstate and Columbia. Your Impact: You'll 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. You'll support patients/employees receiving benefits under insurance lines including Workers' Compensation, Group Health, Liability, Disability, and Care Management. This is your chance to grow your career, earn great rewards, and enjoy true work-life balance. Apply today and make an impact in the Columbia community!

Our Company Explore how you can contribute at AmeriLife. For over 50 years, AmeriLife has been a leader in the development, marketing and distribution of annuity, life and health insurance solutions for those planning for and living in retirement. Associates get satisfaction from knowing they provide agents, marketers and carrier partners the support needed to succeed in a rapidly evolving industry. Job Summary We are seeking an experienced Medical Case Manager with a background in high-net-worth cases to join our team. This role involves assessing medical records for new business applications and working closely with clients, advisors, carrier medical underwriters, case managers, and internal teams to deliver customized underwriting solutions. The ideal candidate will bring a minimum of 5 years of experience in medical underwriting within a carrier environment, with a demonstrated track record of handling high-net-worth clients and complex cases. Job Description Key Responsibilities: Risk Assessment: Review and evaluate medical information, history, and lifestyle factors to assess risk accurately for new business applications, ensuring alignment with company guidelines and risk appetite. High Net-Worth Client Underwriting: Apply expertise in high-net-worth client underwriting, providing tailored assessments and recommendations for sophisticated cases with large policy values. Collaboration with Advisors and Agents: Work closely with sales agents, brokers, and advisors to discuss underwriting decisions, alternative solutions, and provide education on medical underwriting considerations. Decision-Making: Make informed, independent underwriting decisions, backed by solid analysis and within authorized limits; escalate complex cases as necessary. Documentation and Compliance: Maintain accurate records of underwriting decisions, ensuring full compliance with company policies, procedures, and regulatory requirements. Continuous Improvement: Stay updated on industry trends, medical advancements, and changes in underwriting guidelines, and contribute insights for policy updates and risk management strategies. Qualifications: Experience: Minimum of 5 years in medical underwriting, ideally within a life insurance carrier environment, with demonstrated expertise in new business underwriting for high-net-worth clients. Medical Knowledge: Strong understanding of medical terminology, conditions, and risk factors, with the ability to apply this knowledge to high-stakes underwriting cases. Analytical Skills: Strong analytical skills, with the ability to evaluate complex medical and financial information effectively. Communication Skills: Excellent verbal and written communication skills, with the ability to explain underwriting decisions to both technical and non-technical stakeholders. Attention to Detail: High degree of accuracy and attention to detail in assessing risk and documenting decisions. Compliance Knowledge: Familiarity with industry regulations, compliance standards, and underwriting best practices. Equal Employment Opportunity Statement We are an Equal Opportunity Employer and value diversity at all levels of the organization. All employment decisions are made without regard to race, color, religion, creed, sex (including pregnancy, childbirth, breastfeeding, or related medical conditions), sexual orientation, gender identity or expression, age, national origin, ancestry, disability, genetic information, marital status, veteran or military status, or any other protected characteristic under applicable federal, state, or local law. We are committed to providing an inclusive, equitable, and respectful workplace where all employees can thrive. Americans with Disabilities Act (ADA) Statement We are committed to full compliance with the Americans with Disabilities Act (ADA) and all applicable state and local disability laws. Reasonable accommodations are available to qualified applicants and employees with disabilities throughout the application and employment process. Requests for accommodation will be handled confidentially. If you require assistance or accommodation during the application process, please contact us at ****************. Pay Transparency Statement We are committed to pay transparency and equity, in accordance with applicable federal, state, and local laws. Compensation for this role will be determined based on skills, qualifications, experience, and market factors. Where required by law, the pay range for this position will be disclosed in the job posting or provided upon request. Additional compensation information, such as benefits, bonuses, and commissions, will be provided as required by law. We do not discriminate or retaliate against employees or applicants for inquiring about, discussing, or disclosing their pay or the pay of another employee or applicant, as protected under applicable law. Pay ranges are available upon request. Background Screening Statement Employment offers are contingent upon the successful completion of a background screening, which may include employment verification, education verification, criminal history check, and other job-related inquiries, as permitted by law. All screenings are conducted in accordance with applicable federal, state, and local laws, and information collected will be kept confidential. If any adverse decision is made based on the results, applicants will be notified and given an opportunity to respond.

This is an RN position that specifically requires experience in STI, PrEP/PEP clinical care with an interest in supporting programmatic STI, PrEP/PEP services. Reporting to the Case Manager Supervisor and/or their designee, the Medical Case Manager is responsible for providing daily care coordination, case management, and direct patient care. This position works with HIV/AIDS and Hepatitis-C infected individuals. The incumbent will work as part of an interdisciplinary care team including, but not limited to, coordinating patient services such non- medical case management, mental health and substance abuse treatment and integration of primary medical and specialty care. This position provides health education for patients with an emphasis on medication adherence and treatment compliance. This position works as part of the Integrated Behavioral Health Case Management team. Contacts and interactions vary and may involve multiple constituencies such as direct interaction with THC's executive management, community organizers, the general public, THC's patients, physicians, colleagues, assigned staff, vendors, contractors and consultants for the purpose of providing and exchanging information. Example of Essential Job Functions Manages a caseload of patients Ensures all intake assessments are completed Ability to assess clients for needs related to treatment education, risk reduction and prevention. Responsible for All new patients and employees are properly oriented to the unit (i.e. understand rules, policies, procedures, sign consent/release of information forms) Responsible for developing, implementing and evaluating individualized patient care plans Establishes long and short term goals for the patient which are S-M-A-R-T(Smart, Measurable, Achievable, Realistic, Timely) Educates patients regarding the disease process and medications, methods for improving medication compliance, available community resources and other pertinent information. Ensure the patients are linked to care management and staff adhere to appropriate lines of communication regarding the work being done with patients Directs and monitors team members in implementing patient's care plan. Maintains extensive knowledge regarding the current standards of HIV/AIDS care and case management processes. Ensure quality care is delivered in an efficient and effective manner. Ensure customer service standards are continuously demonstrated. Engaging patients and their care givers in understanding and setting self-management plans in a culturally and linguistically appropriate manner. Facilitates and coordinates services to develop patient-centered, individualized, integrated patient care plans, including self-management and outcomes goals. Collaborate with various health care providers across the care continuum to ensure that patients are effectively managed and that health care needs are met. Ensure that advance preparations for patients are coordinated for providers and with patients. Participates in patient centered interdisciplinary care conferences and meetings as required. Responsible for care in collaboration with the patient's physician, the patient and/or family representative, and other members of the professional staff Acts as a liaison between patients, their families and healthcare providers Providing clinical expertise for assigned patient population Reassessing all treatment plans according to policy and as needed Improve patients' quality of life through collaboration and follow up care Facilitate collaboration between community health education resources and the patients Assist patients with creating, monitoring and documentation of self-management goals and follow up with patients regarding set goals Communicates to other team members regarding the status of patients' social and mental health needs Monitor patients' use of health center services and the adequateness and effectiveness of the services utilized, including patient flow Develops and maintains policies and procedures as required Participates in professional development opportunities and attends staff/team meetings as deemed necessary Documents in medical record per policy and standards Maintains accurate and up-to-date records in a timely manner Provides in-service training, and on-the-job training to new staff within the scope of service Assist with audits and quality issues Provide services in clinic within the scope of services of license as directed by Supervisory staff. Facilitates referrals to specialty care and support services Follows up on all medical care related referrals and documents all contact and outcome in the medical record. Interacts with providers, including specialists, to ensure comprehensive care for the patients Disseminates information and educates the provider community and patients regarding the latest treatment protocols in HIV/AIDS management. Collaborates with ASOs and other community services in the Eligible Metropolitan Area (EMA), including specialty care providers, as necessary to ensure appropriate access to services and follow-up on the results to such referrals Effectively tracks outcomes of care on an individual and aggregate basis regarding the patients Monitors patients acuity level in an ongoing fashion to ensure transition to reduced intensity of services when patient is no longer an acuity level that necessitates medical case management. Communicates with all team members about changes to level of services Maintains information in a confidential manner in compliance with HIPAA and confidentiality policies and procedures. Participation in required Ryan White staff meetings Clinical coverage for direct patient care when needed Performs other duties as assigned within the scope of license. Required Knowledge, Skills and Abilities Knowledge of FQHC operations, operating principles, guidelines and bylaws. Excellent leadership, customer service, organizational and presentation skills as well as the ability to effectively communicate THC's vision, and motivate others to achieve it organizationally, departmentally, and personally/professionally. Ability to communicate effectively (verbally and in writing). Ability to plan and organize work initiatives to successfully accomplish center/organizational goals and objectives. Ability to multi-task, prioritize and delegate as appropriate. Strong analytical, problem solving and interpersonal skills. Ability to identify, develop and implement short/long-term strategic goals and objectives. Ability to develop and maintain customer relationships; influence, build credibility and trust. Ability to think critically as well as apply critical thinking skills. Ability to: ensure and advocate for quality healthcare and services; and, lead and manage a diverse staff. Must have demonstrated knowledge of HIV/AIDS services in Maryland, along with an interest and ability to expand knowledge through training. Knowledge of the federal 340B program and its requirements. Licenses and Certifications RN License

Reporting to the Case Management Supervisor and/or their designee, the Non-Medical Case Manager is responsible for providing Non-Medical Case Management Services, that include EFA and Co-Morbidity Services and monitoring Ryan White eligibility. Contacts and interactions vary and may involve multiple constituencies such as direct interaction with THC's executive management, community organizers, the general public, THC's patients, physicians, colleagues, assigned staff, vendors, contractors and consultants for the purpose of providing and exchanging information. Example of Essential Job Functions Manages a caseload of patients Ensures all intake assessments are completed and assessments are reviewed semi-annually Ability to assess clients for needs related to treatment education, risk reduction and prevention. Responsible for all new patients are properly oriented to the unit (i.e. understand rules, policies, procedures, sign consent/release of information forms) Responsible for developing, implementing and evaluating individualized patient care plans Establishes long and short term goals for the patient which are S-M-A-R-T(Smart, Measurable, Achievable, Realistic, Timely) Ensure the patients are linked to care management and staff adhere to appropriate lines of communication that promote team based and patient centered care Ensure that advance preparations for patients are coordinated for providers and with patients. Participates in patient centered interdisciplinary care conferences and meetings as required. Acts as a liaison between patients, their families and healthcare providers Improve patients' quality of life through collaboration and follow up care Ensure customer service standards are continuously demonstrated. Facilitate collaboration between community health education resources and the patients Assist patients with creating, monitoring and documentation of self-management goals and follow up with patients regarding set goals, identify for needs assessment. Effectively tracks outcomes of care on an individual and aggregate basis regarding the patients Gathers and documents attempts to gather program eligibility information. Assist with navigation in patients' use of health center services Participates in professional development opportunities and attends staff/team meetings as deemed necessary Documents in medical record per policy and standards Provides in-service training, and on-the-job training to new staff within the scope of service Maintains information in a confidential manner in compliance with HIPAA and confidentiality policies and procedures. Performs other duties as assigned. Travel is required Minimum Education, Training and Experience Required AA Degree Required Bachelor's Level Degree preferred One year Case Management experience preferred

Reporting to the Case Management Supervisor and/or their designee, the Non-Medical Case Manager is responsible for providing Non-Medical Case Management Services, that include EFA and Co-Morbidity Services and monitoring Ryan White eligibility. Contacts and interactions vary and may involve multiple constituencies such as direct interaction with THC's executive management, community organizers, the general public, THC's patients, physicians, colleagues, assigned staff, vendors, contractors and consultants for the purpose of providing and exchanging information. Example of Essential Job Functions * Manages a caseload of patients * Ensures all intake assessments are completed and assessments are reviewed semi-annually * Ability to assess clients for needs related to treatment education, risk reduction and prevention. * Responsible for all new patients are properly oriented to the unit (i.e. understand rules, policies, procedures, sign consent/release of information forms) * Responsible for developing, implementing and evaluating individualized patient care plans * Establishes long and short term goals for the patient which are S-M-A-R-T(Smart, Measurable, Achievable, Realistic, Timely) * Ensure the patients are linked to care management and staff adhere to appropriate lines of communication that promote team based and patient centered care * Ensure that advance preparations for patients are coordinated for providers and with patients. * Participates in patient centered interdisciplinary care conferences and meetings as required. * Acts as a liaison between patients, their families and healthcare providers * Improve patients' quality of life through collaboration and follow up care * Ensure customer service standards are continuously demonstrated. * Facilitate collaboration between community health education resources and the patients * Assist patients with creating, monitoring and documentation of self-management goals and follow up with patients regarding set goals, identify for needs assessment. * Effectively tracks outcomes of care on an individual and aggregate basis regarding the patients * Gathers and documents attempts to gather program eligibility information. * Assist with navigation in patients' use of health center services * Participates in professional development opportunities and attends staff/team meetings as deemed necessary * Documents in medical record per policy and standards * Provides in-service training, and on-the-job training to new staff within the scope of service * Maintains information in a confidential manner in compliance with HIPAA and confidentiality policies and procedures. * Performs other duties as assigned. * Travel is required Minimum Education, Training and Experience Required * AA Degree Required * Bachelor's Level Degree preferred One year Case Management experience preferred

✨Join a group of passionate advocates on our mission to improve the lives of youth! Rite of Passage Team is hiring for a Medical Case Manager at Southern California Treatment Program in Costa Mesa, CA ✨ Rite of Passage's Southern California Treatment Program is located in a thriving community known for its cultural diversity, sunny weather, and proximity to world-class educational institutions, that allows our team members to enjoy an inspiring and supportive environment where they can make a meaningful impact while growing both personally and professionally. Pay: Rate starting at $23.00 per hour; $1000.00 Sign-On Bonus for Full-Time Clinical position paid out at 3 and 6 Months! Perks and Benefits: Medical, Dental, Vision, company paid Life Insurance, eligibility for a 403(b) match of up to 6% after 1 year of employment, Paid Time Off that begins accruing on the first day, and more! See complete list here: ATCS Benefits & Perks What you will do: You will be responsible for coordinating medication management services, scheduling monthly/quarterly psychiatry appointments, coordinating care with all providers to ensure client's mental health stability and their successful transition back to the community. To be considered you must: Demonstrate empathy, patience, and respect, along with a genuine desire to work with troubled teens. ~ Successfully pass a criminal background check, drug screening, physical exam, and TB test. ~ Hold a current State Driver's License with an acceptable driving record for the past three years. ~ Retain one of the following combinations: Associates level degree in a related field with three years of experience, or Bachelor's level degree in a related field with two years of related experience in mental health service provision. Relevant experience includes, but not limiting to working with youth in mental health setting, treatment services, residential, schools, after-school programs, or coaching sports Information regarding Schedule/hours/shifts: Shifts: Monday - Friday 9:00 am - 6:00 pm Apply today and Make a Difference in the Lives of Youth! After 40 years of improving the lives of youth, we are looking for passionate advocates to continue the legacy of helping young people become successful adults. As a Medical Case Manager , you will have the unique opportunity to create a positive, safe and supportive environment for the youth we serve while building a career rich in growth opportunities and self-fulfillment. Follow us on Social! Instagram / Facebook / Linkedin / Tik Tok / YouTube