Workers Compensation Telephonic Nurse Case Manager

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

📋 Description

• Evaluate, plan, coordinate, monitor, assess, and implement options and services to ensure timely medical care and facilitate return-to-work outcomes for injured workers.

• Organize and execute medical case management to support case resolution.

• Communicate effectively with employers, adjusters, and injured workers.

• Evaluate the utilization of medical treatments and services by liaising with physicians and other specialists to guarantee cost-effective, high-quality care.

• Analyze and review medical records, assessing data to ensure appropriate case management, and recommending actions to promote case progression and closure.

• Manage assigned caseloads, which may vary by number, territory, and/or state jurisdiction.

• Obtain and maintain nursing licensure in jurisdictions as required by business needs.

• Coordinate home services, durable medical equipment, independent medical exams (IMEs), admissions, discharges, and vocational services, while evaluating cost-effectiveness and quality.

• Document activities and case advancements utilizing appropriate methods and tools in line with quality-improvement best practices.

• Review job analyses/descriptions with providers and employers to facilitate effective disability case management and return-to-work processes.

• Engage in special projects assigned by case management leadership.

• Occasionally attend on-site meetings and professional development programs.

• Maintain and update evidence-based medical guidelines and state-regulated guidelines for treatment plans and work status.

• Acquire and sustain relevant state certifications and/or licenses.

• Achieve case management professional certification (CCM) within two years of hire.

• Complete continuing education units to maintain certifications and licenses.

• Promote a collaborative team environment.

⛳️ Requirements

• A minimum of 2 years of experience in workers' compensation insurance and medical case management is preferred.

• Ability to work during Pacific Standard Time business hours.

• California RN license is highly preferred.

• At least 4 years of medical/surgical clinical experience is required.

• Strong communication skills, professionalism, flexibility, and adaptability are essential.

• Working knowledge of medical and vocational resources pertinent to the Workers’ Compensation field.

• Proven self-motivation and the capability to perform case management tasks independently.

• Demonstrated proficiency in computer and technology skills.

• Fluency in both Spanish and English, both orally and in writing, is a plus.

• Graduate of an accredited nursing school with a current RN license.

• RN compact license is preferred.

• CCM certification is preferred.

• Bachelor’s degree in Nursing is preferred.

• Domestic U.S. travel may be required (up to 10% of the time).

• Sponsorship is not offered for this role.

🏝️ Benefits

• Health

• Dental

• Vision

• Life

• Disability

• Wellness

• Paid Time Off

• 401(k)

• Profit-Sharing plans

• Competitive compensation plan

• Comprehensive benefits package for full-time regular employees