Telephonic Nurse Case Manager

Athens Administrators has been a dynamic, innovative leader in claims administration since 1976. We foster an environment where employees thrive, offering opportunities for continuous professional growth within our nationwide, family-owned company specializing in Workers' Compensation, Property & Casualty, Program Business, and Managed Care.

About the role

Athens Administrators has an immediate need for a full-time Telephonic Nurse Case Manager to support our Managed Care Department. This remote position is open to candidates located in California, Colorado, Nevada, Texas, Oregon, Idaho, Arizona, or Oklahoma, provided technical requirements are met. The role follows a Monday–Friday, 9:00 AM to 5:00 PM Pacific Time schedule.

The Telephonic Nurse Case Manager researches and recommends resources, creating flexible, cost-effective options for injured, catastrophically, or chronically ill individuals on a case-by-case basis to facilitate quality individualized treatment goals, including timely return to work when appropriate. This position also assists the unit in maintaining a successful program, which may include developing workflows, reporting, staff recruitment, and training.

Responsibilities

• Organize and review medical records to identify specific medical issues; provide information and recommendations to appropriate parties.
• Maintain regular contact with all involved parties to facilitate communication and provide medical and vocational management and coordination services.
• Arrange prompt and appropriate medical treatment by qualified providers, adhering to regulatory provider-choice requirements.
• Schedule appointments to avoid delays in treatment by primary care physicians, specialists, or ancillary services.
• Assist the treating physician in developing a written treatment plan, including referrals to other providers.
• Attend doctor and/or attorney visits, hospital and/or long-term facility discharge planning conferences, as needed, to determine care appropriateness and develop long-term care strategies.
• Work with medical providers to track progress, modify treatment plans, and ensure maximum medical improvement.
• Obtain medical reports and required work status forms; ensure all parties receive appropriate reports.
• Develop Independent Medical Evaluation Plans; provide assessment, planning, implementation, and evaluation of patient progress.
• Facilitate authorization/certification of procedures, diagnostic testing, physical/occupational therapy, and durable medical equipment to prevent treatment delays.
• Cooperate with the treating physician to obtain full or conditional release for return to work before a lost-time claim occurs; update conditions as treatment progresses.
• Assess the injured worker, their support system, and family; make referrals for educational, financial, psychological, or other human services as needed.
• Coordinate with employers to develop modified-duty jobs consistent with physical restrictions assigned by the treating doctor.
• Educate employers on the benefits of accommodating injured workers to retain them in the workforce.
• Provide vocational services to identify goals and develop early return-to-work plans when return to the same employer is not possible.
• Research medical and community resources for patients with catastrophic or chronic diagnoses (e.g., AIDS, cancer, spinal cord injury, diabetes, head injury, burns).
• Maintain constant contact with the assigned adjuster through calls, emails, and written reports; respect decision-making authority limits.
• Satisfy documentation and reporting requirements for each customer.
• Maintain continuing education per state license requirements and stay updated on workers’ compensation and federal healthcare laws.
• Assist the unit with workflow development, best practices, reporting templates, and training needs.
• Ensure regular and consistent attendance.
• Travel to other branches for training or file reviews as needed.
• Comply with all safety rules and regulations in conjunction with the Injury and Illness Prevention Program (IIPP).

Requirements

• Master’s or Bachelor’s degree in Nursing, or Associate’s Degree in Nursing from an accredited school, with equivalent work experience.
• CCM, CIRS, CRRN, COHN, or other related designation preferred.
• Master’s or Bachelor’s degree in a related field with CCM, CDMS, or CRC designation also preferred.
• Active RN license from any U.S. state required at hire; current California RN licensure required within one year (if not already obtained).
• California RN application must be submitted within the first two weeks of hire (Athens reimburses licensing fees).
• 3+ years of workers’ compensation case management experience or related field.
• Strong clinical background in orthopedics, neurology, or rehabilitation is useful.
• Cost-containment experience, such as utilization review or managed care, is also useful.
• Extensive, clear, and tactful communication skills required (written, verbal, telephone, note-taking, memoranda).
• Strong negotiation skills.
• Ability to work effectively with minimal direct supervision.
• Well-developed verbal and written communication skills with strong attention to detail.
• Excellent organizational skills and ability to multitask.
• Proficient typing skills for prolonged periods.
• Ability to use a computer mouse, touchpad, or other input devices frequently and for extended durations.
• Proficient in Microsoft Office Suite; ability to learn additional computer programs.
• Strong reasoning, problem-solving, and analytical skills to research facts, identify issues, and recommend solutions.
• Trustworthy, dependable, and team-oriented with a commitment to service and results.
• Ability to demonstrate care and concern for team members and clients in a professional and friendly manner.
• Acts with integrity in challenging situations; maintains honesty when handling confidential, proprietary, or sensitive information (e.g., health records, client financials).

Schedule

Monday–Friday, 9:00 AM to 5:00 PM Pacific Time.