Triage Telephonic Nurse Case Manager

About the role

The Triage Telephonic Case Manager (RN) plays a crucial role in the medical management of Workers’ Compensation claims. This position involves conducting initial triage, performing clinical assessments, developing case management care plans, and facilitating communication among various stakeholders.

Responsibilities

• Conduct initial triage and telephonic case management at the outset of Workers’ Compensation claims.
• Perform clinical assessments of injured workers to determine appropriate medical care and treatment pathways.
• Complete initial assessment and required three-point contact in accordance with State of Florida procedures and emergency protocols.
• Develop an initial case management care plan based on clinical findings and information obtained from the injured worker, employer, and medical provider.
• Identify potential causation concerns or barriers to recovery and document findings appropriately.
• Facilitate communication between injured workers, employers, claims professionals, healthcare providers, and rehabilitation specialists.
• Maintain accurate and timely documentation of all contacts, interviews, and medical information in the claims management system.
• Monitor treatment plans to ensure adherence to state-mandated treatment guidelines and evidence-based medical protocols.
• Address initial return-to-work capabilities with injured workers and providers, documenting updates in the case management system.
• Educate injured workers and their families about recovery expectations and care plans.
• Maintain strict patient confidentiality and comply with state and federal healthcare regulations.
• Serve as a patient advocate, ensuring quality care and adherence to ethical and regulatory standards.
• Participate in quality assurance initiatives, committees, and department activities as required.
• Aid in training claims staff on identifying medical case management opportunities, as needed.

Requirements

• Registered Nurse (RN) with an active and unrestricted state license.
• Minimum of 3 years of clinical nursing experience (medical-surgical, orthopedic, neurological, ICU/CCU, occupational health, or related specialty).
• Prior telephonic case management or triage experience preferred.
• Strong understanding of clinical documentation and patient advocacy principles.
• Strong clinical assessment and triage skills in a Workers’ Compensation or occupational health environment.
• Knowledge of Workers’ Compensation medical case management practices and treatment guidelines.
• Ability to identify barriers to recovery and develop appropriate care strategies.
• Excellent verbal and written communication skills, with the ability to work collaboratively with multiple stakeholders.
• Strong organizational and documentation skills with attention to detail.
• Ability to work independently and manage multiple priorities in a fast-paced environment.
• Proficiency with computer systems, case management software, and Microsoft Office applications.
• Commitment to high-quality patient care, confidentiality, and regulatory compliance.

Skills

• Strong clinical assessment and triage skills in a Workers’ Compensation or occupational health environment.
• Knowledge of Workers’ Compensation medical case management practices and treatment guidelines.
• Ability to identify barriers to recovery and develop appropriate care strategies.
• Excellent verbal and written communication skills, with the ability to work collaboratively with multiple stakeholders.
• Strong organizational and documentation skills with attention to detail.
• Ability to work independently and manage multiple priorities in a fast-paced environment.
• Proficiency with computer systems, case management software, and Microsoft Office applications.

Benefits

• 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.
• Benefit offerings, eligibility, and required employer contributions may vary based on role, classification, and applicable federal, state, and local laws, including those tied to an employee’s primary work location.

Pay

$66,000 - $67,000 / year

Schedule

Full-time