RN Workers Compensation Case Manager

About the role

A Telephonic Nurse Case Manager provides telephonic medical case management for workers' compensation injury cases. The role involves independent assessment, planning, coordination, and advocacy to meet the injured worker's health needs using effective communication and evidence-based resources. This process supports optimal physical, psychosocial, and vocational outcomes while facilitating timely, cost-effective, and clinically appropriate care.

Responsibilities

• Independent assessment, planning, coordination, and advocacy for injured workers' health needs
• Adheres to applicable jurisdictional requirements and reports directly to the Clinical Manager
• Completes timely two-point initial contact within 48 hours, including injured worker assessment and provider verification; escalates high-risk cases appropriately
• Develops, implements, and proactively manages individualized treatment plans to ensure timely, appropriate, and cost-effective care
• Covers medical services, including therapy, diagnostics, DME, and ancillary services to support recovery and compliance
• Edits and guides injured workers on diagnosis, treatment plans, recovery expectations, and return-to-work goals
• Maintains ongoing communication with providers and comprehensive medical record review, and timely coordination of care
• Evaluates treatment plans, medical necessity, and causation; coordinates and facilitates utilization review (UR), IMEs, and peer review as needed
• Manages medication oversight, reconciliation, safety, and appropriateness
• Drives timely and safe return-to-work planning in collaboration with employers and stakeholders
• Participates in case reviews, strategy roundtable discussions; collaborates with adjusters, legal teams, and departmental leadership to support optimal claim outcomes
• Maintains accurate, timely, and compliant documentation in all required systems; ensures regulatory and policy adherence
• Performs other duties as assigned

Requirements

• Strong working knowledge of workers’ compensation case management, injury care, and treatment protocols
• Demonstrated clinical assessment, critical thinking, and independent decision-making skills
• Proficient in Microsoft Office and case management systems
• Excellent verbal, written, and interpersonal communication skills across multidisciplinary teams
• Strong organizational skills and attention to detail in medical documentation and case management activities
• Ability to manage multiple cases independently in a fast-paced, deadline-driven environment
• Ability to adapt in a high-pressure environment while maintaining quality and compliance
• Ability to perform sedentary work, including prolonged sitting and computer use
• Strong knowledge of workers’ compensation processes, regulations, and case management practices
• Understanding of medical terminology, clinical care, and evidence-based treatment protocols
• Ability to interpret complex medical records and apply clinical judgment to support workers’ compensation case management and treatment planning
• Knowledge of injury management, disability management, and return-to-work principles
• Understanding of medical necessity, causation, and appropriate treatment planning
• Knowledge of documentation standards, confidentiality, and regulatory compliance (e.g., HIPAA)
• Effective professional communication skills for interaction with providers, adjusters, and injured workers, and leadership
• Knowledge of Epic electronic medical record (EMR) system
• Preferred: Knowledge of evidence-based treatment guidelines (e.g., ODG -Official Disability Guidelines) and workers’ compensation clinical review processes, including utilization review (UR), independent medical examinations (IMEs), and peer review principles
• Understanding of workers’ compensation cost-containment strategies, including medical cost projections and resource utilization

Qualifications

• Associate's of Nursing [Required]
• Bachelor's of Nursing [Preferred]

Skills

• Strong working knowledge of workers’ compensation case management, injury care, and treatment protocols
• Demonstrated clinical assessment, critical thinking, and independent decision-making skills
• Proficient in Microsoft Office and case management systems
• Excellent verbal, written, and interpersonal communication skills across multidisciplinary teams
• Strong organizational skills and attention to detail in medical documentation and case management activities
• Ability to manage multiple cases independently in a fast-paced, deadline-driven environment
• Ability to adapt in a high-pressure environment while maintaining quality and compliance
• Ability to perform sedentary work, including prolonged sitting and computer use
• Strong knowledge of workers’ compensation processes, regulations, and case management practices
• Understanding of medical terminology, clinical care, and evidence-based treatment protocols
• Ability to interpret complex medical records and apply clinical judgment to support workers’ compensation case management and treatment planning
• Knowledge of injury management, disability management, and return-to-work principles
• Understanding of medical necessity, causation, and appropriate treatment planning
• Knowledge of documentation standards, confidentiality, and regulatory compliance (e.g., HIPAA)
• Effective professional communication skills for interaction with providers, adjusters, and injured workers, and leadership
• Knowledge of Epic electronic medical record (EMR) system
• Preferred: Knowledge of evidence-based treatment guidelines (e.g., ODG -Official Disability Guidelines) and workers’ compensation clinical review processes, including utilization review (UR), independent medical examinations (IMEs), and peer review principles
• Understanding of workers’ compensation cost-containment strategies, including medical cost projections and resource utilization

Benefits

Extensive benefits package including medical, dental, vision insurance, life insurance, disability insurance, paid time off, 403-B retirement plan, whole person well-being resources, mental health resources and support, pet benefits, career development, and more.

Pay

$68,132.50 - $119,520.35

Schedule

Full time, Shift: Day