Remote Medical Case Manager, Workers' Comp Specialist

Tristar Insurance; South Carolina; Hybrid; USD 85,000 - 90,000; Full time

Benefits offered by this job

Medical, Dental, Vision Insurance.

Life and Disability Insurance.

401(k) Plan

Paid Holidays

Paid Time Off.

Referral bonus.

Job summary

Tristar Insurance in SC is seeking an experienced Medical Case Manager to provide telephonic case management in workers' compensation. You will coordinate care, assess medical status, and facilitate return-to-work planning with employers, providers, and claimants.

Responsibilities include outreach, data review, treatment coordination, and maintaining confidentiality while meeting URAC standards. RN license and CCM preferred; strong communication and organization are essential.

Qualifications

• Excellent communication and organizational skills required.
• RN licensing and nursing degree preferred; CCM/CPDM/COHN/CDMS certifications encouraged.
• Experience in workers' compensation or managed care is a plus.

Responsibilities

• Provide telephonic outreach for assessment and follow‑up for case communication and coordination.
• Conduct initial assessment with injured worker, employer, and provider and maintain contact to formulate a clinical plan.
• Coordinate contact with provider, claimant, RTW contact, and claims examiner.
• Review case records, analyze data, and define needs to provide proactive case management.
• Assess medical records for treatment appropriateness and refer to Medical Director as needed.
• Facilitate timely return to work by coordinating RTW with claimant, employer, and physicians.
• Maintain communication of case activity with all parties involved.
• Monitor medical appointments to address RTW and treatment plan; negotiate with physicians.

Skills

Excellent communication

Organizational skills

Telephonic outreach

RN license

Education

Nursing degree (Diploma/AA/BSN)

RN license

CCM certification

Tools

Microsoft Office (Word/Excel/PowerPoint)

Job description

Tristar Insurance in SC is seeking an experienced Medical Case Manager to provide telephonic case management in workers' compensation. You will coordinate care, assess medical status, and facilitate return-to-work planning with employers, providers, and claimants.

Responsibilities include outreach, data review, treatment coordination, and maintaining confidentiality while meeting URAC standards. RN license and CCM preferred; strong communication and organization are essential.