Medical Case Manager – Telephonic Case Management

TRISTAR Insurance Group

Medical Case Manager providing telephonic case management in workers' compensation environment. Coordinating resources and treatment goals while facilitating return-to-work placements.

Posted 7/23/2026full-timeRemote • South Carolina • 🇺🇸 United StatesMid-LevelSenior💰 $85,000 - $92,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in medical case management, including assessment, planning, and coordination of care for injured workers. Proficient in utilizing clinical knowledge to facilitate communication among stakeholders and promote positive treatment outcomes.

Highest-signal resume keywords

Registered Nurse (RN) LicenseCertified Case Manager (CCM)Medical Case Management ExperienceUtilization Management KnowledgeAcute Care Clinical Experience

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Assessment and PlanningData Collection and AnalysisClinical Case ManagementTreatment Plan NegotiationMedical Record Review

Soft Skills

Problem SolvingCommunicationCoordination

Tools & Technologies

Microsoft Office Suite

Certifications & Qualifications

Licensed Practical Nurse (LPN)Certified Case Manager (CCM)CPHURCPDMCOHNCDMS

Industry Keywords

Worker’s CompensationManaged CareQuality ImprovementDischarge PlanningCost Management

About the role

Key responsibilities & impact

Provide telephonic outreach for assessment, and follow up for case communication and coordination to include assessing, planning, implementing, coordinating of care.
Conducts and documents initial assessment with the injured worker, employer and provider and maintain regular contact with all parties involved to facilitate communication and to formulate a clinical case plan.
Responsible for coordination of contact with provider, claimant, RTW contact and claims examiner.
Reviews case records and reports, collects and analyzes data, evaluates client's medical status and defines needs and problems in order to provide proactive case management services.
Assessment of medical records for appropriateness of treatment and level of care being provided.
Referral to the Medical Director if appropriate within the established timeframes.
Facilitate timely return to work date coordinating RTW with the claimant, employer and physicians.
Maintains contact and communicates updated activity with all parties involved with the case.
Telephonically monitor medical appointments of the injured worker to address RTW, current treatment plan and identify potential issues and promote positive treatment outcomes.
Negotiate treatment plan with treating physician.

Requirements

What you’ll need

Diploma, Associate or Bachelor’s degree in Nursing, Master’s level (or higher) in a Nursing, Health or Human Services field or equivalent related experience preferred.
Current, unrestricted Registered Nurse (RN), Licensed Practical Nurse (LPN) and or Certified Case Manager (CCM) license required.
CCM, CMCN, CPHUR, CPDM, COHN or CDMS certification preferred.
Three or more years of diverse clinical experience in acute care.
Two or more years of medical case management or managed care experience, Worker’s Compensation background preferred.
Knowledge of utilization management, quality improvement, discharge planning, and or cost management.
Ability to solve practical problems and deal with a variety of variables.
Proficient with Microsoft Office applications including Word, Excel, and PowerPoint.

Benefits

Comp & perks

Medical, Dental, Vision Insurance.
Life and Disability Insurance.
401(k) Plan
Paid Holidays
Paid Time Off.
Referral bonus.