Nurse Case Manager

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
• Must meet productivity & quality expectations
• Ability to independently and effectively organize and prioritize daily work