RN Case Manager: Care Coordination & Utilization Review

InterMed Cost Containment Services; Texas; On-site; USD 78,000 - 85,000; Full time

Benefits offered by this job

Medical, dental, vision benefits

401(k) with company match

Paid time off and holidays

Job summary

AvonRisk is seeking a Medical Case Management nurse (RN) to ensure maximum medical and disability improvement through early intervention and coordinated care for injured workers in California. The role emphasizes evidence-based guidelines and collaboration with physicians, claims teams, and employers.

Responsibilities include triage, pre-authorization, utilization review, and ensuring timely communication among all parties.

Qualifications

• Candidate must have an active and good standing RN license in the state of residence.
• Minimum of 1 year clinical experience.
• Should be familiar with California Workers’ Compensation, Managed Care experience/Utilization Review experience recommended

Responsibilities

• Coordinate medical care and ensure timely, appropriate treatment.
• Communicate with physicians, injured workers, employers, and claims adjustors.
• Perform utilization review based on medical necessity.
• Identify medical diagnoses and validate treatment plans.
• Refer to guidelines such as MTUS, ACOEM, MCG, ODG for care decisions

Skills

Multitasking

Organization

Time management

Team collaboration

Follow directions

Education

Current and valid RN license; compact license preferred

Job description

AvonRisk is seeking a Medical Case Management nurse (RN) to ensure maximum medical and disability improvement through early intervention and coordinated care for injured workers in California. The role emphasizes evidence-based guidelines and collaboration with physicians, claims teams, and employers.

Responsibilities include triage, pre-authorization, utilization review, and ensuring timely communication among all parties.