RN Telephonic Nurse Case Manager

Key Responsibilities

• Manage a caseload of Workers’ Compensation claims through telephonic case management services
• Conduct comprehensive initial and ongoing assessments of injured employees’ medical status, treatment progress, and recovery needs
• Develop, implement, and monitor individualized case management plans to promote optimal medical outcomes.
• Review medical records, treatment recommendations, and clinical information to determine appropriateness of care.
• Identify barriers to recovery and develop action plans to facilitate progress toward recovery and return-to-work goals.
• Monitor adherence to evidence-based treatment guidelines, utilization criteria, and regulatory requirements.
• Evaluate treatment plans and document clinical outcomes, recovery progress, and return-to-work milestones.
• Act as a liaison among injured employees, employers, healthcare providers, insurers, attorneys, and other authorized stakeholders.
• Facilitate effective communication to ensure alignment on treatment plans, recovery goals, and return-to-work expectations.
• Establish and maintain strong client relationships through professional service and responsive communication.
• Serve as a patient advocate while maintaining compliance with legal, ethical, and regulatory standards.
• Address return-to-work capabilities with injured employees and treating providers during ongoing case reviews.
• Collaborate with employers and providers to support transitional or modified duty opportunities when appropriate.
• Obtain and review job descriptions to assist providers in evaluating work capacity and restrictions.
• Promote timely and medically appropriate return-to-work outcomes.
• Maintain accurate, timely, and comprehensive case documentation within designated systems.
• Ensure compliance with state Workers’ Compensation regulations, client requirements, and company policies.
• Protect confidential medical information in accordance with HIPAA and applicable privacy regulations.
• Support utilization review processes, including pre-authorization, concurrent review, retrospective review, and medical director referrals as needed.
• Monitor provider and vendor performance to ensure quality service delivery.
• Identify opportunities for process improvement and operational efficiencies.
• Participate in quality assurance, grievance, and other organizational committees as assigned.
• Provide clinical education and support to internal staff and stakeholders when appropriate.
• Assist with training, mentoring, or guidance of less experienced team members as requested.
• Perform other duties as assigned.

Skills, knowledge & expertise

• Minimum three (3) years of clinical nursing experience in one or more of the following areas: 
  • Medical-Surgical
  • Orthopedics
  • Neurology
  • Critical Care/ICCU
  • Emergency Room
  • Occupational Health
  • Industrial Nursing
• Workers’ Compensation case management experience preferred.
• Telephonic case management experience preferred.
• Current, unrestricted Registered Nurse (RN) license in the applicable state(s).
• Ability to maintain active licensure throughout employment.
• Strong clinical assessment and critical thinking skills.
• Knowledge of Workers’ Compensation processes, regulations, and medical case management principles.
• Understanding of evidence-based treatment guidelines and disability management practices.
• Ability to manage multiple priorities independently in a fast-paced environment.
• Strong organizational and time-management skills.
• Excellent verbal and written communication skills.
• Ability to build collaborative relationships with diverse stakeholders.
• Strong customer service orientation and professionalism.
• Proficiency with Microsoft Office applications and case management software systems.
• Ability to maintain confidentiality and exercise sound clinical judgment.
• Minimal travel may be required based on business needs.