RN Case Manager & Utilization Review Specialist

AvonRisk; Austin (TX); Hybrid; USD 78,000 - 87,000; Full time

Benefits offered by this job

Medical, dental, and vision benefits

HSA/FSA plans

Life and disability insurance

401(k) with company match

PTO and holidays

Job summary

AvonRisk is hiring a Medical Case Management nurse in Texas for a hybrid role combining case management and utilization review. You will coordinate care, assess medical necessity, and work with the claims team to drive timely, evidence-based decisions for injured workers.

The position requires an active California RN license and at least 1 year of clinical experience, with preferred familiarity in California workers’ compensation and UR processes. Competitive benefits are included.

Qualifications

• Must possess an active California RN license; relevant clinical scope.
• Minimum of 1 year of clinical experience.
• Familiarity with California Workers’ Compensation; managed care/UR experience recommended.
• IEA CA 10 class within 1 year of employment if no prior workers’ compensation experience.

Responsibilities

• Triage all claims within 24 hours of assignment.
• Make initial contacts and documentations within 72 hours where applicable.
• Initiate disability management to identify lost time and coordinate return-to-work.
• Address medical issues for assigned claims and coordinate care for optimum outcomes.
• Review treatment plans using evidence-based guidelines and state regulations.

Skills

Self-motivated

Multi-tasking

Organization

Time management

Teamwork

Follow directions

Education

California RN license

Clinical experience (1 year)

CA Workers’ Compensation knowledge

IEA CA 10 class within 1 year

Job description

AvonRisk is hiring a Medical Case Management nurse in Texas for a hybrid role combining case management and utilization review. You will coordinate care, assess medical necessity, and work with the claims team to drive timely, evidence-based decisions for injured workers.

The position requires an active California RN license and at least 1 year of clinical experience, with preferred familiarity in California workers’ compensation and UR processes. Competitive benefits are included.