Workers Compensation - Telephonic Nurse Case Manager (Remote)

Responsibilities

• Assess, plan, coordinate, monitor, evaluate and implement options and services to facilitate timely medical care and return to work outcomes of injured workers.
• Carefully communicate with employers, adjusters, and injured workers to coordinate medical case management.
• Assess the appropriateness of medical treatments and services available through interactions with physicians and specialists to ensure cost-effective, high-quality care.
• Analyze medical records and assess data to ensure proper case management processes occur while making recommendations to advance case progress and closure.
• Manage assigned caseloads, which can vary in size, territory, and state jurisdiction, and acquire and maintain necessary licenses as needed.
• Coordinate services such as home services, durable medical equipment, IMEs, admissions, discharges, and vocational services when necessary, evaluating cost-effectiveness and quality of services.
• Document activities and case progress using appropriate methods and tools, adhering to best practices for quality improvement.
• Review job descriptions with providers to facilitate return to work and coordinate disability case management.
• Maintain and update evidence-based medical guidelines relevant to the injured worker's treatment plan and work status.
• Evaluate and obtain applicable state certifications and/or licenses in the state where job duties are performed.
• Earn continuing education units to maintain certifications and licenses.

Qualifications

• Minimum 2 years of experience in workers' compensation insurance and medical case management preferred.
• Minimum of 4 years of medical/surgical clinical experience required.
• Strong communication skills, professionalism, flexibility, and adaptability.
• Working knowledge of medical and vocational resources available to the Workers' Compensation industry.
• Demonstrated self-motivation and ability to perform case management duties independently.
• Computer and technology skills, oral and written fluency in both Spanish and English a plus.

Education

• Graduate of an accredited school of nursing.
• Possess a current RN license.
• RN compact license preferred.
• CCM preferred.
• Bachelor of Nursing preferred.

Additional Company Details

The Company is an equal employment opportunity employer. We do not accept unsolicited resumes from external recruiting agencies or firms. The company offers a competitive compensation plan and robust benefits package for full-time regular employees. Benefits include Health, Dental, Vision, Life, Disability, Wellness, Paid Time Off, 401(k) and Profit-Sharing plans. The base salary range for this position is $75k-$88k, with the actual salary determined by various factors including the scope, complexity, and location of the role; the candidate's skills, education, training, credentials, and experience; and other conditions of employment. Domestic U.S. travel is required (up to 10% of time).