Provide telephonic case management for Workers’ Compensation cases.
Assess medical appropriateness of treatment plans and coordinate services to optimize recovery and cost efficiency.
Develop, implement, and modify individualized case management care plans.
Perform ongoing clinical assessments and review medical records to ensure quality and timely care.
Identify and address barriers to recovery with proactive action planning.
Coordinate communication between injured workers, employers, providers, insurers, and other stakeholders.
Promote and document return-to-work capability at each medical milestone.
Ensure compliance with state-mandated treatment guidelines, nationally published protocols, and client requirements.
Track outcomes including patient satisfaction, return-to-work progress, and disability duration.
Utilize utilization review tools when indicated (pre-certification, concurrent review, retrospective review, medical director review).
Monitor provider and vendor performance to ensure quality and appropriate care delivery.
Maintain detailed and accurate documentation within the case management system.
Serve as a patient advocate while adhering to all legal, ethical, accreditation, and regulatory standards.
Participate in Quality Assurance, Grievance, or other committees as assigned.
Provide training or mentorship to claims staff or junior team members as appropriate.
Perform additional duties as assigned.

Active, unrestricted RN license.
Minimum 3 years of clinical experience (medical-surgical, orthopedic, neurological, ICCU, industrial, ER, or occupational health).
Workers’ Compensation case management experience preferred.
Strong knowledge of treatment guidelines and utilization management principles.
Excellent verbal and written communication skills.
Ability to work independently in a remote environment.
Proficiency in computer systems and claims/case management software.
Telephonic case management experience.
Experience applying evidence-based disability duration guidelines.
Prior experience training or mentoring staff.

Medical, dental, and vision plans to support your health and that of your family
A 401(k) plan with employer matching
Time-off policies, including Discretionary Time Off (DTO) for exempt employees and Paid Time Off (PTO) for non-exempt employees
Paid holidays
Life insurance and short-term and long-term disability coverage

RN Telephonic Nurse Case Manager

Key skills