Nurse Case Manager - Workers' Comp & Return to Work

Evolving Solution Services; Northern (KY); Hybrid; USD 75,000 - 105,000; Full time

Job summary

Evolving Solution Services seeks a Registered Nurse I to deliver comprehensive medical case management for a public sector workers' compensation and return-to-work program in Washington, DC. You will coordinate care with injured workers, physicians, and agency stakeholders to support timely recovery and safe return to work.

The ideal candidate holds a DC RN license, a nursing degree, and at least one year of specialized nursing experience, with strong communication and documentation skills to

Qualifications

• Graduation from an accredited professional nursing program.
• Current licensure as a Registered Nurse in the District of Columbia.
• At least one year of specialized professional nursing experience involving medical assessment, planning, implementation, utilization review, and evaluation of patient progress.

Responsibilities

• Provide comprehensive medical case management services in support of a workers' compensation and return to work program.
• Conduct medical assessments and evaluate injured workers' clinical status, treatment plans, and recovery progress.
• Develop, implement, monitor, and revise individualized case management plans to promote recovery and support safe return to work outcomes.
• Coordinate and manage care among injured workers, treating physicians, specialists, rehabilitation providers, and other stakeholders.
• Review medical records, treatment plans, and utilization requests to determine medical necessity and appropriateness of care.
• Conduct utilization review, treatment plan review, and medical billing review.
• Identify claims suitable for return to work initiatives and help develop transitional duty assignments and workplace accommodations.
• Establish return to work status, projected recovery timelines, maximum medical improvement targets, and work restrictions based on medical evidence.
• Communicate regularly with injured workers, supervisors, providers, and claims examiners regarding case status and treatment progress.
• Prepare medical status reports, case summaries, and documentation to support claim administration.
• Provide consultation and guidance to agency personnel on workers' compensation medical management and return to work strategies.

Skills

Clinical assessment

Case management

Communication

Documentation

Education

Nursing degree

Tools

EMR systems

Claims systems

Job description

Evolving Solution Services seeks a Registered Nurse I to deliver comprehensive medical case management for a public sector workers' compensation and return-to-work program in Washington, DC. You will coordinate care with injured workers, physicians, and agency stakeholders to support timely recovery and safe return to work.

The ideal candidate holds a DC RN license, a nursing degree, and at least one year of specialized nursing experience, with strong communication and documentation skills to