Telephonic Nurse Case Manager (Remote)

Department: Claims Administration & Adjusting

Employment Type: Permanent - Full Time

Location: Home United States

Reporting To: Karen Shaffer

Description

Key Responsibilities

• Providing telephonic case management in a Workers’ Compensation environment while focusing on medical appropriateness of care to injured worker with cost savings by coordination and utilization of all services, ensuring that as soon as medically feasible, return-to-work status is achieved, along with increase in productivity
• Facilitating communication between the employee, the employee representative, employer, employer representative, insurer, health care provider, the medical services organization and when authorized, any qualified rehabilitation consultant, to achieve the goals
• Ensuring appropriate, progressive education is provided to the injured employee in a consistent manner while documenting in the system
• Identifying barriers to recovery and formulating a plan to overcome the barriers
• Clinically evaluating the recovery needs of an injured employee after the initial contact assessment and providing ongoing assessment of health and medical records
• Evaluating treatment plans while tracking and modifying appropriately, and documenting outcomes; developing alternative treatment plans as necessary
• Tracking protocol management for appropriate utilization and delivery of medical services
• Serving as a patient advocate adhering to all legal, ethical and accreditation/regulatory standards
• Exhibit company values of We are Dynamic, We are Innovative, We are Connected, and We Succeed Together
• Perform other duties as assigned

Skills, knowledge & expertise

• RN with 3-5 years clinical experience (medical-surgical, orthopedic, neurological, ICCU, industrial or occupational)
• Must possess one of the following certifications: CCRN, CCM, CDMS, COHN, COHN‐S if managing a WC/MCO claim
• At least 1 years’ experience handling Workers’ Compensation case management
• Proof of current State Licensure and eligible for endorsement in all other states
• Bi-lingual – fluent English/Spanish helpful
• Case-management experience mandatory – at least 1 year Workers’ Compensation
• Field case or catastrophic case management and utilization review experience is highly preferred
• Ability to demonstrate strong focus on cost containment to manage cases in most cost-effective way while still ensuring quality medical care
• Maintain knowledge of current trends, standards and law changes appropriate to the law at the date of injury
• Must be self-directed and able to work independently
• Ability to effectively operate a personal computer and related claims and business software.
• Good communication skills, both oral and written
• Must be a team player with superb customer service skills

Equal Employment Opportunity & Legal Notices

• 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

• Maintain regular and dependable attendance.
• Be available and able to perform job responsibilities during established work hours.