Workers Compensation, Telephonic Nurse Case Manager

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

📋 Description

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

• Oversee and execute medical case management to support the closure of cases.

• Ensure prompt and thorough communication with employers, adjusters, and injured workers.

• Assess the appropriate use of medical treatments and services by liaising with physicians and specialists to guarantee cost-effective, high-quality care.

• Review and scrutinize medical records and data to confirm the effective management of cases, providing recommendations to promote case advancement and closure.

• Manage assigned caseloads, which may differ in number, geographical area, and/or state jurisdiction.

• Obtain and retain nursing licensure across all necessary jurisdictions based on business requirements.

• Coordinate services such as home care, durable medical equipment, independent medical examinations (IMEs), admissions, discharges, and vocational services when suitable, while assessing cost efficiency and service quality.

• Record activities and case progress using suitable methods and tools, adhering to best practices for quality enhancement.

• Collaborate with all providers to review job analyses/job descriptions to facilitate and implement disability case management, including coordinating job analysis with employers to support return-to-work efforts.

• Participate in special projects as directed by the case management leadership team.

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

• Promote a collaborative team environment.

• Maintain and update evidence-based medical guidelines (such as Official Disability Guidelines, MD Guidelines, and other state-regulated guidelines) related to the treatment plans and work status of injured workers.

• Secure and sustain relevant state certifications and/or licenses in the state where job responsibilities are executed.

• Achieve professional case management certification (CCM) within two years from the hire date.

• Complete Continuing Education Units to uphold certifications and licenses.

⛳️ Requirements

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

• A minimum of 4 years of clinical experience in medical/surgical settings is required.

• Demonstrate strong communication abilities, professionalism, flexibility, and adaptability.

• Have a solid understanding of medical and vocational resources available within the Workers’ Compensation sector.

• Show evidence of self-motivation and the capacity to perform case management tasks independently.

• Exhibit proficiency in computer and technology skills.

• Bilingual proficiency in both Spanish and English is a plus.

🏝️ Benefits

• Health

• Dental

• Vision

• Life

• Disability

• Wellness

• Paid Time Off

• 401(k)

• Profit-Sharing plans