Remote RN Case Manager – Telephonic Workers’ Comp

Fairweather, LLC; United States; On-site; USD 75,000 - 80,000; Full time

Benefits offered by this job

Medical/Dental/Vision plans

401(k) with employer matching

Paid time off

Paid holidays

Life insurance

Disability coverage

Job summary

Davies North America is seeking an RN Telephonic Nurse Case Manager to coordinate medical care for injured employees in a Workers' Compensation environment. This role serves as a clinical resource and advocate, facilitating communication among stakeholders and promoting safe return-to-work outcomes.

You will manage a caseload, conduct assessments, review treatment plans, ensure HIPAA-compliant documentation, and collaborate with employers, providers, and insurers.

Qualifications

• Current, unrestricted RN license in the applicable state(s).
• Minimum three (3) years of clinical nursing experience.

Responsibilities

• Manage a caseload of Workers' Compensation claims through telephonic case management services.
• Conduct comprehensive initial and ongoing assessments of injured employees' medical status, treatment progress, and recovery needs.
• Develop, implement, and monitor individualized case management plans to promote optimal medical outcomes.
• Review medical records, treatment recommendations, and clinical information to determine appropriateness of care.
• Identify barriers to recovery and develop action plans to facilitate progress toward recovery and return-to-work goals.
• Monitor adherence to evidence-based treatment guidelines, utilization criteria, and regulatory requirements.
• Evaluate treatment plans and document clinical outcomes, recovery progress, and return-to-work milestones.
• Act as a liaison among injured employees, employers, healthcare providers, insurers, attorneys, and other authorized stakeholders
• Facilitate effective communication to ensure alignment on treatment plans, recovery goals, and return-to-work expectations
• Establish and maintain strong client relationships through professional service and responsive communication
• Serve as a patient advocate while maintaining compliance with legal, ethical, and regulatory standards
• Address return-to-work capabilities with injured employees and treating providers during ongoing case reviews
• Collaborate with employers and providers to support transitional or modified duty opportunities when appropriate
• Obtain and review job descriptions to assist providers in evaluating work capacity and restrictions
• Promote timely and medically appropriate return-to-work outcomes
• Maintain accurate, timely, and comprehensive case documentation within designated systems
• Ensure compliance with state Workers' Compensation regulations, client requirements, and company policies
• Protect confidential medical information in accordance with HIPAA and applicable privacy regulations
• Support utilization review processes, including pre-authorization, concurrent review, retrospective review, and medical director referrals as needed
• Monitor provider and vendor performance to ensure quality service delivery
• Identify opportunities for process improvement and operational efficiencies
• Participate in quality assurance, grievance, and other organizational committees as assigned
• Provide clinical education and support to internal staff and stakeholders when appropriate
• Assist with training, mentoring, or guidance of less experienced team members as requested
• Perform other duties as assigned

Skills

Nursing

Telephonic case management

Workers' Compensation

Clinical assessment

Communication

Microsoft Office

Case management software

Education

RN license (state licença)

Tools

Case management software

Microsoft Office

Job description

Davies North America is seeking an RN Telephonic Nurse Case Manager to coordinate medical care for injured employees in a Workers' Compensation environment. This role serves as a clinical resource and advocate, facilitating communication among stakeholders and promoting safe return-to-work outcomes.

You will manage a caseload, conduct assessments, review treatment plans, ensure HIPAA-compliant documentation, and collaborate with employers, providers, and insurers.