Telephonic Nurse Case Manager
MDD Forensic Accountants
full-time
Posted on:
Location Type: Remote
Location: United States
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Salary
💰 $80,000 - $90,000 per year
Job Level
About the role
- Provide specialized telephonic case management for complex and catastrophic Workers’ Compensation claims
- Direct injured employees to appropriate specialty care while maintaining a strong focus on cost containment
- Monitor, analyze, and coordinate high-quality, timely, and cost-effective medical treatment
- Perform comprehensive medical assessments and develop individualized, outcome-focused case management plans
- Facilitate communication among injured workers, employers, adjusters, providers, insurers, and other stakeholders
- Identify barriers to recovery and proactively develop strategies to address them
- Monitor vendor performance and ensure quality delivery of medical services
- Track, evaluate, and document treatment plans, outcomes, and recovery progress in the case management system
- Assess and document return-to-work capabilities and identify modified or alternative duty options when appropriate
- Manage cases in compliance with state-mandated treatment guidelines, utilization criteria, and evidence-based protocols applicable to the date of injury
- Create, edit, and revise correspondence and case documentation
- Utilize utilization review tools when indicated, including prospective, concurrent, and retrospective review, and physician advisor consultation
- Educate injured workers and families on treatment plans, recovery expectations, and care coordination
- Maintain strict confidentiality of all medical and case information in accordance with state and federal regulations
- Serve as a patient advocate while adhering to all legal, ethical, and regulatory standards
- Negotiate provider fees or refer cases to alternate vendors when appropriate and compliant with statutory requirements
- May provide guidance or informal leadership to less-experienced staff
- Perform other duties as assigned
Requirements
- Registered Nurse (RN) with 3–5 years of clinical experience in areas such as medical-surgical, orthopedic, neurological, ICU/CCU, industrial, or occupational health
- Must hold one of the following certifications: CCRN, CCM, CDMS, COHN, or COHN-S (required for WC/MCO claims)
- Minimum one (1) year of Workers’ Compensation case management experience
- Current, unrestricted state RN licensure and eligibility for licensure endorsement in other state
- Minimum one (1) year of Workers’ Compensation case management experience (required)
- Experience with catastrophic or complex case management and utilization review (preferred)
- Demonstrated ability to balance quality medical care with cost containment strategies
- Strong knowledge of Workers’ Compensation statutes, treatment guidelines, and regulatory requirements
- Ability to work independently and manage a complex, multi-jurisdictional caseload
- Proficiency with case management systems and standard business software
- Excellent written and verbal communication skills
- Strong organizational skills, attention to detail, and customer service orientation
- Team-oriented mindset with dependable attendance
Benefits
- Medical, dental, and vision plans to ensure your health and that of your family.
- A 401k plan with employer matching to help you build a secure financial future.
- Our time-off policies, including Discretionary Time Off for exempt employees and Paid Time Off (PTO) package for non-exempt employees, reflect our commitment to promoting a healthy work environment.
- Paid holidays.
- Life insurance and both short-term and long-term disability plans, providing essential financial protection for you and your loved ones.
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
case managementmedical assessmentsutilization reviewcost containment strategiesreturn-to-work capabilitiestreatment plansoutcome-focused planningnegotiationdocumentationbarrier identification
Soft Skills
communicationorganizational skillsattention to detailcustomer service orientationindependent workleadershipteam-oriented mindsetadvocacyproblem-solvingstrategic development
Certifications
Registered Nurse (RN)CCRNCCMCDMSCOHNCOHN-S