Nurse Case Manager

Medical Case Manager - CT08GE
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Nurse Case Manager

This fully remote role provides telephonic case management for injured workers. The Nurse Case Manager assesses, plans, and coordinates care to support recovery and timely return to work. Using clinical expertise, this role develops proactive strategies, collaborates with key stakeholders, and drives cost-effective medical and claim outcomes.

Key Responsibilities

• Conduct comprehensive clinical assessments using telephonic interviews, medical records, and data from multiple sources, addressing complex conditions including co-morbidities and biopsychosocial factors
• Develop and implement individualized case management strategies to support medical stability and timely return to work
• Identify complex cases requiring additional coordination and collaborate with internal and external stakeholders to evaluate injury, causation, and work capacity
• Apply clinical guidelines, company policies, and regulatory requirements to ensure compliant and appropriate case management decisions
• Utilize a holistic approach to focus on medical care and functional recovery, promoting efficient treatment and return-to-work outcomes
• Partner with supervisors and cross-functional teams to address barriers, resolve issues, and support overall claim performance through meetings and case reviews

• RN with current unrestricted state licensure (CA is preferred)
• Associate's Degree in Nursing required

• Minimum 3 years of clinical experience in one or more of the following:
  • Acute care
  • Orthopedics
  • Rehabilitation
  • Occupational/industrial health
  • Behavioral health
  • Disability Case management
• CCM, CDMS, CRC, CVE, and/or current CRRN or willingness to pursue
• Bachelor's degree in nursing
• Workers Compensation case management experience

• Proficiency in Microsoft Office and navigating multiple systems
• Ability to effectively communicate telephonically and in written form.
• Work requires the ability to perform close inspection of handwritten and computer generated documents as well as a PC monitor.
• Ability to synthesize large volumes of medical records & facilitate multi-point care coordination
• Must meet productivity & quality expectations
• Ability to independently and effectively organize and prioritize daily work

• Candidates located near one of the company's office locations are expected to work in the office three days per week (Tuesday-Thursday).
• Candidates who do not live near an office location may work fully Remote, with occasional in-office presence as business needs require.