RN Case Manager: Care Coordination & Utilization Review

AvonRisk; Texas; On-site; USD 78,000 - 85,000; Full time

Benefits offered by this job

HSA & FSA

Life & disability insurance

401(k) with match

Paid time off

Learning & development

Employee assistance program

Job summary

AvonRisk is seeking a Medical Case Management nurse to ensure maximum medical and disability improvement through proactive intervention. You will coordinate with physicians, the injured worker, and employers to achieve optimal claim outcomes with evidence-based care.

The role requires an active RN license in the state of residence and experience in workers’ compensation or UR is preferred. A strong focus on communication and collaboration with the claims team is essential.

Qualifications

• Active RN license in the state of residence.
• Minimum of 1 year clinical experience.
• Familiar with California Workers’ Compensation and Managed Care Utilization Review is recommended.

Responsibilities

• Triage all claims within 24 hours of assignment.
• Make initial contacts and documentation within 72 hours when applicable.
• Initiate disability management to identify anticipated lost time and coordinate return to work.
• Address medical issues for the claim and coordinate timely, appropriate medical care.
• Review treatment plans for medical appropriateness based on evidence-based guidelines.
• Identify medical diagnoses and validate treatment plans with care algorithms.

Skills

Self-motivation

Multi-tasking

Organizational skills

Time management

Team collaboration

Follow directions

Education

Current and valid RN license

Compact license preferred

Minimum 1 year clinical experience

Job description

AvonRisk is seeking a Medical Case Management nurse to ensure maximum medical and disability improvement through proactive intervention. You will coordinate with physicians, the injured worker, and employers to achieve optimal claim outcomes with evidence-based care.

The role requires an active RN license in the state of residence and experience in workers’ compensation or UR is preferred. A strong focus on communication and collaboration with the claims team is essential.