RN Clinical Referral Manager - Workers Compensation

RN Clinical Referral Manager - Workers Compensation Job Description

Posted Tuesday, August 25, 2026 at 5:00 AM

Paradigm is an accountable specialty care management organization focused on improving the lives of people with complex injuries and diagnoses. The company has been a pioneer in value-based care since 1991 and has an exceptional track record of generating the very best outcomes for patients, payers, and providers. Deep clinical expertise is the foundation for every part of Paradigm’s business: risk-based clinical solutions, case management, specialty networks, home health, shared decision support, and payment integrity programs.

We’re proud to be recognized—again! For the fourth year in a row, we’ve been certified by Great Place to Work®,and for the third consecutive year, we’ve earned a spot on Fortune's Best Workplaces in Health Care™ list . These honors reflect our unwavering commitment to fostering a positive, inclusive, and employee-centric culture where people thrive.

Watch thisshort video for a brief introduction to role of a nurse case manager at Paradigm.

Paradigm is hiring a Clinical Referral Manager for a remote, full-time, benefited position. The
Clinical Referral Manager provides clinical support for the Catastrophic Referral Intake Unit.

The schedule for this position is Monday through Friday, 8 AM to 5 PM Pacific time (9 AM to 6 PM Mountain time, 10 AM to 7 PM Central time, or 11 AM to 8 PM Eastern time).

Responsibilities:

• Assist with assignment of the Primary Medical Team and Network Managers to new referrals.
• Evaluate incoming and existing referrals to determine appropriate product placement based on specified criteria.
• Assist the Catastrophic Referral Intake Unit in reviewing new referral escalations for appropriate product placement.
• Assess clinical conditions, treatment plans, and required resources. Escalate referrals that need additional or advanced services.
• Identify key stakeholders and responsible parties for each referral. Build and maintain strong relationships with stakeholders to ensure effective handling of catastrophic referrals.
• Provide education and support to customers regarding Paradigm products and services.
• Review active field case management files to identify opportunities for conversion to risk-bearing products.
• Analyze referrals that were unstaffed or withdrawn, gather relevant data, and provide insights to the sales team for potential conversion.
• Develop strategies to increase the scope of referrals considered for conversion and collaborate with other business units to implement these processes.
• Track and maintain data on referral conversions, including revenue and cases that were not successfully converted.

Qualifications:

EDUCATION & EXPERIENCE

REQUIRED:

• Registered Nurse (with active, unencumbered license)
• Minimum of 3-5 years’ experience in catastrophic case management, referral intake or sales
• Experience in insurance preferred.
• Demonstrated ability to define, manage and modify operational processes and workflows.
• Demonstrated ability to work collaboratively to address operational and customer requests.
• Intermediate to advanced level computer experience and Windows software, proficient in Microsoft product suite with advanced skills in Excel.

KNOWLEDGE SKILLS & ABILITIES:

• Exceptional critical-thinking and creative problem-solving skills with proven ability to collaborate with others to identify alternatives and drive to resolution.
• Strong communication and facilitation skills including the ability to resolve issues and build consensus among groups of diverse internal/external stakeholders;
  Ability to deliver effective presentations to internal and external customers.
• Ability to work effectively autonomously and/or in a matrixed environment;
  Ability to be flexible and responsive to change.
• Excellent interpersonal skills with an ability to influence and lead through change.
• Ability to review and assess complex medical records and convey pertinent information to non-medical stakeholders
• Experience working as a Network Manager and using EDDG preferred
• Health and wellness
  – We want our people to be and stay healthy, so we offer PPO, HDHP, and HMO health insurance options with…