Provide telephonic case management for workers’ compensation claims
Evaluate medical treatment plans for appropriateness and evidence-based care
Coordinate communication between injured worker, employer, adjuster, and providers
Develop and update individualized care plans to support recovery and return-to-work
Identify barriers to recovery and implement action plans to address them
Monitor medical progress and functional status throughout treatment
Educate injured workers regarding treatment plans and recovery expectations
Facilitate return-to-work discussions with providers and employers
Ensure compliance with state guidelines, clinical protocols, and client requirements
Utilize utilization review tools when appropriate (pre-certification, concurrent review, retrospective review)
Document case activity and medical updates in claims systems accurately and timely
Maintain confidentiality in accordance with HIPAA and regulatory standards
Support client relationships through professional communication and service excellence
Participate in quality assurance activities and training as needed

Active RN license (compact license preferred)
3+ years clinical nursing experience (ER, ICU, Med-Surg, Ortho, Neuro, Occupational, or similar)
3+ years Workers’ Compensation case management experience
Ability to independently manage a caseload in a remote environment
Strong written and verbal communication skills
Certified Case Manager (CCM) or related certification preferred
Experience with utilization review processes
Experience working with multiple jurisdictions or state guidelines
Knowledge of workers’ compensation medical management and return-to-work principles
Understanding of treatment guidelines and disability duration concepts
Strong critical thinking and clinical assessment abilities
Ability to build rapport with injured workers and providers
Effective time management and organization skills
Proficiency in case management and claims software systems

Medical, dental, and vision plans to ensure your health and that of your family.
A 401k plan with employer matching to help you build a secure financial future.
Our time-off policies, including Discretionary Time Off for exempt employees and Paid Time Off (PTO) package for non-exempt employees, reflect our commitment to promoting a healthy work environment.
Paid holidays.
Life insurance and both short-term and long-term disability plans, providing essential financial protection for you and your loved ones.

RN Telephonic Nurse Case Manager

Key skills