Triage Telephonic Nurse Case Manager

This is a fully remote position, open to applicants in Alabama.

📋 Description

• Perform initial triage and telephonic case management at the beginning of Workers’ Compensation claims.

• Conduct clinical evaluations of injured workers to ascertain suitable medical treatment and care pathways.

• Complete the initial assessment and necessary three-point contact in alignment with Florida state procedures and emergency protocols.

• Formulate an initial case management care plan based on clinical findings and information gathered from the injured worker, employer, and medical provider.

• Detect potential causation issues or obstacles to recovery and accurately document findings.

• Facilitate communication among injured workers, employers, claims professionals, healthcare providers, and rehabilitation specialists.

• Oversee treatment plans to confirm adherence to state-mandated treatment guidelines and evidence-based medical practices.

• Discuss initial return-to-work capabilities with injured workers and providers, recording updates in the case management system.

• Ensure precise and timely documentation of all contacts, interviews, and medical information within the claims management system.

• Identify opportunities for cost-efficient medical management and suitable service utilization.

• Educate injured workers and their families regarding recovery expectations and care plans.

• Uphold strict patient confidentiality and adhere to state and federal healthcare regulations.

• Act as a patient advocate, ensuring quality care and compliance with ethical and regulatory standards.

• Engage in quality assurance initiatives, committees, and departmental activities as necessary.

• Assist in training claims staff on recognizing medical case management opportunities, as required.

⛳️ Requirements

• Active and unrestricted Registered Nurse (RN) state license.

• At least 3 years of clinical nursing experience (medical-surgical, orthopedic, neurological, ICU/CCU, occupational health, or a related specialty).

• Preferred experience in Workers’ Compensation case management.

• Prior experience in telephonic case management or triage is preferred.

• Strong knowledge of clinical documentation and patient advocacy principles.

• Excellent clinical assessment and triage skills in a Workers’ Compensation or occupational health setting.

• Familiarity with Workers’ Compensation medical case management practices and treatment guidelines.

• Ability to recognize barriers to recovery and formulate suitable care strategies.

• Exceptional verbal and written communication skills, capable of collaborating with multiple stakeholders.

• Strong organizational and documentation abilities with a keen attention to detail.

• Capacity to work independently and manage various priorities in a dynamic environment.

• Proficient in computer systems, case management software, and Microsoft Office applications.

• Dedication to high-quality patient care, confidentiality, and compliance with regulations.

🏝️ 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.