Hybrid RN Case Manager: Utilization Review

AvonRisk LLC; Austin, Northern (TX, KY); Hybrid; USD 78,000 - 87,000; Full time

Benefits offered by this job

Medical, dental, vision benefits

401(k) with company match

PTO and holidays

Learning and development opportunities

Job summary

AvonRisk LLC is seeking a Medical Case Management nurse in Texas for a hybrid role combining case management and utilization review. The nurse coordinates care, communicates with providers, the injured worker, and employer to achieve optimal medical and disability outcomes.

Responsibilities include triage within 24 hours, early case management, and utilization review using evidence-based guidelines. California-specific rules apply, with emphasis on cost-effective treatment and client advocacy.

Qualifications

• Active California RN license required.
• Minimum 1 year clinical experience.
• Familiarity with California Workers’ Compensation and UR recommended.
• IEA CA 10 class within 1 year if no prior workers’ compensation experience.

Responsibilities

• Triage all claims within 24 hours of assignment.
• Complete initial contacts and documentation within 72 hours when applicable.
• Coordinate disability management and return-to-work processes.
• Address medical issues to ensure timely, appropriate care and optimum outcomes.
• Perform utilization review based on medical guidelines and state rules.

Skills

Self-motivation

Multitasking

Adaptability

Organizational skills

Time management

Teamwork

Communication

Education

California RN license

CA workers' compensation knowledge

IEA CA 10 class completion

Job description

AvonRisk LLC is seeking a Medical Case Management nurse in Texas for a hybrid role combining case management and utilization review. The nurse coordinates care, communicates with providers, the injured worker, and employer to achieve optimal medical and disability outcomes.

Responsibilities include triage within 24 hours, early case management, and utilization review using evidence-based guidelines. California-specific rules apply, with emphasis on cost-effective treatment and client advocacy.