16 medical case manager i jobs found

The Telephonic Case Manager coordinates resources and develops cost-effective, personalized care plans for ill or injured individuals. The goal is to support quality treatment and, when appropriate, a timely return to work. This role uses clinical expertise to assess the appropriateness of current treatment plans based on the patient’s medical and physical condition. The Case Manager communicates directly with treating physicians to evaluate and recommend alternative care options when needed. They also explain medical conditions and treatment plans to patients, family members, and adjusters, while supporting the objectives of the Case Management department and of CorVel. This is a remote position, but all candidates must reside in one of the following states: NE, IA, MO, KS. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Provide medical case management to individuals through coordination with the patient, the physician, other health care providers, the employer, and the...

The Bilingual Telephonic Case Manager coordinates resources and develops cost-effective, personalized care plans for ill or injured individuals. The goal is to support quality treatment and, when appropriate, a timely return to work. This role uses clinical expertise to assess the appropriateness of current treatment plans based on the patient’s medical and physical condition. The Case Manager communicates directly with treating physicians to evaluate and recommend alternative care options when needed. They also explain medical conditions and treatment plans to patients, family members, and adjusters, while supporting the objectives of the Case Management department and of CorVel. This is a remote position, but all candidates must reside in one of the following states: NE, IA, MO, KS. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Provide medical case management to individuals through coordination with the patient, the physician, other health care providers, the employer,...

Job Description: We are looking to add a Sr. Workers’ Compensation Claims Specialist, Supervisor to join our Creative Risk Solutions team. The ideal candidate will have jurisdictional experience in multiple states . This team member will provide high quality claims handling oversight and expertise for all CRS customers on litigated and complex claim situations. This includes assisting staff supervised with investigating, communicating, evaluating, and resolving claims utilizing the CRS Best Practice of Claim Handling. Assisting claim staff with goals, career pathing, and ensuring engagement. Essential Responsibilities: Claims Management: Adjudicate claims during staffing shortages, investigate, and negotiate settlements per “Best Practices for Claims.” Monitor and document claim files, focusing on Coverage, Investigation, Reserves, Plan of Action, Legal, and Medical Management. Recommend adjustments as needed. Research and respond to questions and complaints...

If you’re passionate about helping people protect what matters most to them at a Fortune 100 company with nearly $70 billion in annual sales, as well as innovating and simplifying processes and operations to provide the best customer value, then Nationwide’s Property and Casualty team could be the place for you! At Nationwide®, “on your side” goes beyond just words. Our customers and partners are at the center of everything we do and we’re looking for associates who are passionate about delivering extraordinary care. Who We’re Looking For We’re seeking early‑career talent who are eager to learn, grow, and build a long‑term career in Claims. We welcome candidates who have graduated since Spring 2024 (or who expect to graduate by Spring 2026).   Location Requirement This role requires working on‑site in Des Moines, IA for approximately 1–2 years to support onboarding, training, and collaboration. After that period, flexibility may be available depending on...

If you’re passionate about helping people protect what matters most to them at a Fortune 100 company with nearly $70 billion in annual sales, as well as innovating and simplifying processes and operations to provide the best customer value, then Nationwide’s Property and Casualty team could be the place for you! At Nationwide®, “on your side” goes beyond just words. Our customers and partners are at the center of everything we do and we’re looking for associates who are passionate about delivering extraordinary care. Who We’re Looking For We’re seeking early‑career talent who are eager to learn, grow, and build a long‑term career in Claims. We welcome candidates who have graduated since Spring 2024 (or who expect to graduate by Spring 2026).   Location Requirement This role requires working on‑site in Des Moines, IA for approximately 1–2 years to support onboarding, training, and collaboration. After that period, flexibility may be available depending on...

Job Description: Creative Risk Solutions (CRS), a proud line of business under the Holmes Murphy umbrella, is a leading Third-Party Administrator (TPA) specializing in innovative claims management solutions. At CRS, we believe in doing things differently—empowering our team to deliver exceptional service, embrace creativity, and make a real impact for our clients. We are looking to add a Workers’ Compensation Claims Specialist to join our team. Experience handling Colorado claims is required. Essential Responsibilities: Receives, gathers and accurately transmits workers’ compensation information to the company, from communications with the insured, claimants, and internal staff in a timely manner. Investigates, evaluates, and resolves lost time Workers’ Compensation claims, including litigated claims. Mediates situations as they arise between the insured and the insurance company, with little to no support from leader, to include researching coverage...

Job Description: Creative Risk Solutions (CRS), a proud line of business under the Holmes Murphy umbrella, is a leading Third-Party Administrator (TPA) specializing in innovative claims management solutions. At CRS, we believe in doing things differently—empowering our team to deliver exceptional service, embrace creativity, and make a real impact for our clients. We are looking to add a Workers’ Compensation Claims Specialist to join our team. Experience handling Colorado claims is required. Essential Responsibilities: Receives, gathers and accurately transmits workers’ compensation information to the company, from communications with the insured, claimants, and internal staff in a timely manner. Investigates, evaluates, and resolves lost time Workers’ Compensation claims, including litigated claims. Mediates situations as they arise between the insured and the insurance company, with little to no support from leader, to include researching coverage...

The Account Manager is responsible for interacting with customers on an executive level and acting as an extension of the client; understanding and communicating agreed upon expectations to field offices and increasing the market share of business by providing service that meets and exceeds customer expectations, stewardship reporting, commitment to customer goals, and introducing/selling/implementing additional services. This is a hybrid position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Provide consultative customer services for one or more new or established accounts Introduce new services independently or with assistance as needed Handle local or regional accounts Manage accounts with revenue in one region and a minimum revenue amount of $1m per account with a combined revenue for all accounts of over $3m. Revenue growth with existing accounts Accounts Receivable - Responsible for all aspects of collections in conjunction with the respective operations...

Job Description: We are looking to add a Sr. Workers’ Compensation Claims Specialist, Supervisor to join our Creative Risk Solutions team. The ideal candidate will have jurisdictional experience in multiple states . This team member will provide high quality claims handling oversight and expertise for all CRS customers on litigated and complex claim situations. This includes assisting staff supervised with investigating, communicating, evaluating, and resolving claims utilizing the CRS Best Practice of Claim Handling. Assisting claim staff with goals, career pathing, and ensuring engagement. Essential Responsibilities: Claims Management: Adjudicate claims during staffing shortages, investigate, and negotiate settlements per “Best Practices for Claims.” Monitor and document claim files, focusing on Coverage, Investigation, Reserves, Plan of Action, Legal, and Medical Management. Recommend adjustments as needed. Research and respond to questions and complaints...

Job Description: We are looking to add a Workers’ Compensation Claims Specialist to join our Creative Risk Solutions team. The ideal candidate will have jurisdictional experience in Iowa, Minnesota, Nebraska, and Wisconsin . Offering a forward-thinking, innovative, and vibrant company culture, along with the opportunity to share your unique potential, there really is no place like Holmes!   Essential Responsibilities: ·    Receives, gathers and accurately transmits workers’ compensation information to the company, from communications with the insured, claimants, and internal staff in a timely manner. ·    Investigates, evaluates, and resolves lost time Workers’ Compensation claims, including litigated claims. ·    Mediates situations as they arise between the insured and the insurance company, with little to no support from leader, to include researching coverage issues. ·   Enters and maintains accurate information on a computer...

Job Description: We are looking to add a Workers’ Compensation Claims Specialist to join our Creative Risk Solutions team. Offering a forward-thinking, innovative, and vibrant company culture, along with the opportunity to share your unique potential, there really is no place like Holmes!   Essential Responsibilities: ·   Receives, gathers and accurately transmits workers’ compensation information to the company, from communications with the insured, claimants, and internal staff in a timely manner. ·  I nvestigates, evaluates, and resolves lost time Workers’ Compensation claims, including litigated claims. ·   Mediates situations as they arise between the insured and the insurance company, with little to no support from leader, to include researching coverage issues. ·   Enters and maintains accurate information on a computer system during the claim process, to include final settlement information. ·   Generates checks for...

Job Description: Creative Risk Solutions (CRS), a proud line of business under the Holmes Murphy umbrella, is a leading Third-Party Administrator (TPA) specializing in innovative claims management solutions. At CRS, we believe in doing things differently—empowering our team to deliver exceptional service, embrace creativity, and make a real impact for our clients. We are looking to add a Workers’ Compensation Claims Specialist to join our team. Experience handling claims in Minnesota, South Dakota, Wisconsin, Pennsylvania, and Iowa is preferred. Essential Responsibilities: Receives, gathers and accurately transmits workers’ compensation information to the company, from communications with the insured, claimants, and internal staff in a timely manner. Investigates, evaluates, and resolves Workers’ Compensation claims. Mediates situations as they arise between the insured and the insurance company, with some support from leader as needed, to include researching...

Job Description: Creative Risk Solutions (CRS), a proud line of business under the Holmes Murphy umbrella, is a leading Third-Party Administrator (TPA) specializing in innovative claims management solutions. At CRS, we believe in doing things differently—empowering our team to deliver exceptional service, embrace creativity, and make a real impact for our clients. We are looking to add a Workers’ Compensation Claims Specialist to join our team. Experience handling claims in Minnesota, South Dakota, Wisconsin, Pennsylvania, and Iowa is preferred. Essential Responsibilities: Receives, gathers and accurately transmits workers’ compensation information to the company, from communications with the insured, claimants, and internal staff in a timely manner. Investigates, evaluates, and resolves Workers’ Compensation claims. Mediates situations as they arise between the insured and the insurance company, with some support from leader as needed, to include researching...

Job Description: We are looking to add a Workers’ Compensation Claims Specialist to join our Creative Risk Solutions team. The ideal candidate will have jurisdictional experience in Iowa, Minnesota, Nebraska, and Wisconsin . Offering a forward-thinking, innovative, and vibrant company culture, along with the opportunity to share your unique potential, there really is no place like Holmes!   Essential Responsibilities: ·    Receives, gathers and accurately transmits workers’ compensation information to the company, from communications with the insured, claimants, and internal staff in a timely manner. ·    Investigates, evaluates, and resolves lost time Workers’ Compensation claims, including litigated claims. ·    Mediates situations as they arise between the insured and the insurance company, with little to no support from leader, to include researching coverage issues. ·   Enters and maintains accurate information on a computer...

Job Description: We are looking to add a Workers’ Compensation Claims Specialist III to join our Creative Risk Solutions team. Offering a forward-thinking, innovative, and vibrant company culture, along with the opportunity to share your unique potential, there really is no place like Holmes!   Essential Responsibilities: ·   Receives, gathers and accurately transmits workers’ compensation information to the company, from communications with the insured, claimants, and internal staff in a timely manner. ·  I nvestigates, evaluates, and resolves lost time Workers’ Compensation claims, including litigated claims. ·   Mediates situations as they arise between the insured and the insurance company, with little to no support from leader, to include researching coverage issues. ·   Enters and maintains accurate information on a computer system during the claim process, to include final settlement information. ·   Generates checks for...

The Medical Allocator creates a cost projection of a patient’s medical treatment needs by reviewing medical records and identifying a pattern of care. The medical cost projection, also knowns as a Medicare Set-Aside (MSA) report, is part of a workers’ compensation or liability claim settlement.  The Medical Allocator will rely on their medical knowledge and guidelines provided by the Centers for Medicare and Medicaid Services (CMS) to evaluate the patient’s treatment plan for future medical treatment needs.  Work from home possible.   ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Collaboration with the claim adjuster Review medical records to prepare a Medicare Set-Aside allocation (MSA) report Perform evidenced based medical research Utilize medical knowledge to outline the patient’s medical treatment. Assign pricing to medical treatment allocations Assign pricing to medication allocations Prepare submission of MSA report to CMS for review and approval...