Telephonic Nurse Case Manager

Responsibilities

• Manage claims involving severe traumatic injuries, spinal cord injuries, traumatic brain injuries, amputations, severe burns, polytrauma, and other catastrophic conditions
• Monitors, coordinates, and evaluates complex and catastrophic workers' compensation claims
• Identify current and anticipated medical needs, including hospitalization, rehabilitation, durable medical equipment (DME), home health services, attendant care, and specialty treatment
• Coordinates medical services with physicians, specialists, rehabilitation providers, hospitals, home health agencies, and ancillary vendors
• Identifies barriers to recovery, treatment compliance, and return-to-work progression and develops appropriate action plans to address them
• Serves as a clinical resource to claims professionals, employers, providers, injured workers, and other stakeholders
• Maintains accurate and timely documentation, clinical summaries, recommendations, and claim notes while ensuring compliance with regulations

• Associate Degree in Nursing required
• Bachelor of Science in Nursing (BSN) preferred
• Current unrestricted Registered Nurse (RN) license required;
  Compact RN licensure preferred
• Minimum of 5 years of direct clinical nursing experience required, preferably in acute care, trauma, critical care, rehabilitation, or a related specialty
• Preferred 3-5 years of catastrophic workers' compensation case management experience
• Experience navigating workers' compensation regulations, medical management practices, treatment guidelines, utilization review processes, and return-to-work programs across multiple state jurisdictions is strongly preferred
• Extensive knowledge of workers' compensation medical management principles
• Strong ability to assess complex medical conditions
• Excellent organizational, written, verbal, and interpersonal communication skills
• Ability to collaborate with multidisciplinary teams and manage multiple priorities while maintaining confidentiality
• Demonstrated proficiency with claims management systems, electronic medical records, and Microsoft Office applications

Demonstrates expertise in managing complex catastrophic workers' compensation claims, including severe traumatic injuries and rehabilitation needs. Proficient in coordinating medical services and navigating workers' compensation regulations while maintaining compliance and effective communication with multidisciplinary teams.