Nurse Case Manager

Salary range: $55,132.00 – $110,642.00 annually + bonus + benefits. Pay is determined by location, education, experience, and other job-related factors within the stated range.

Candidates near the Charleston, WV office will work on-site approximately one day per week. Remote candidates must reside in one of the following payroll-approved states: Connecticut, Delaware, Florida, Georgia, Illinois, Indiana, Iowa, Kansas, Kentucky, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Nebraska, New Hampshire, New Jersey, North Carolina, Ohio, Pennsylvania, South Carolina, Tennessee, Texas, Virginia, West Virginia, or Wisconsin.

About the role

The Nurse Case Manager serves as an office-based skilled medical resource, providing high-quality customer service in workers’ compensation medical case management and utilization review, primarily via telephone. This role delivers medical expertise and plays a critical part in containing medical and indemnity expenses.

Responsibilities

• Complete early medical management assessment and intervention on workers’ compensation claims requiring medical treatment.
• Contact injured workers and medical providers to obtain necessary information.
• Apply knowledge, experience, and evidence-based guidelines to evaluate claims and develop proactive action plans.
• Perform essential medical case management activities: assessment, planning, implementation, monitoring, and evaluation within accepted treatment guidelines.
• Address medical cost containment through utilization management, provider collaboration, and network resource assessment.
• Partner with team members to expedite injured worker recovery, return to work, and reduce disability costs.
• Identify and monitor claims for task assignments to field case managers.
• Evaluate accuracy of injury or disability diagnoses.
• Document recommendations, contacts, actions, and outcomes.
• Adhere to jurisdictional regulations and standards.
• Provide high-quality customer service within a team-based environment.
• Other duties as assigned.

Requirements

• Active, unrestricted Registered Nurse license.
• Minimum of an Associate degree in nursing from an accredited college or university, or successful completion of a diploma nursing program; Bachelor’s or Master’s degree in nursing preferred.
• One year of experience in nurse case management, medical case management, utilization review, or vocational/disability case management; workers’ compensation experience strongly preferred.
• Nationally recognized specialty certification in occupational or rehabilitative nursing or case management (e.g., CCM, CDMS, CRRN, COHN) must be obtained as applicable; certification may substitute for one year of experience.
• Two years of clinical experience in orthopedics, neurology, rehabilitation, internal medicine, or occupational medicine.
• Multi-state case management experience desired.
• Bilingual ability is a plus.
• Ability to collect relevant information, establish facts, draw conclusions, and recommend effective solutions.
• Working knowledge of evidence-based treatment guidelines, protocols, medical causation, and relatedness.
• Ability to coordinate effective medical treatment while maximizing cost containment.
• Strong collaboration skills with multiple team members and stakeholders.
• Excellent planning, organizing, and time-management skills.
• Working knowledge of medical case management theory, principles, and practices.
• Commitment to staying current with trends and developments in medical case management.
• Excellent oral and written communication skills; professionalism, diplomacy, and compassion.
• Proficiency in Microsoft Word, Outlook, and Excel; ability to learn new systems and technologies.
• Ability to work effectively in a paperless environment.

Benefits

• Health, dental, and vision insurance.
• Company-provided life and income protection plans.
• Eligibility to participate in a company incentive bonus program.
• 401(k) Retirement Plan with 100% company match up to 7% of annual salary.
• Paid time off, paid holidays, and floating holidays.
• Flexible work arrangements, including hybrid and remote options depending on the role.