Sr Medical Case Manager-CA

• 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 es...