RN Case Manager: Workers' Comp & Utilization Review

Jobtailor; Dublin (CA); On-site; USD 85,000 - 105,000; Full time

Job summary

Jobtailor is seeking an experienced Registered Nurse to manage a case load of medical and disability workers’ compensation claims in California. The role emphasizes utilization review, telephonic case management, and collaboration with medical professionals and employers.

You will assess injury severity, develop treatment and return-to-work plans, and ensure compliance with Labor Code and company standards while coordinating with panel providers and external resources.

Qualifications

• Must hold RN license in the state of position and be eligible for required states.
• 3+ years of clinical experience in orthopedics, neurology, or occupational medicine preferred.
• CCM/CDMS/CIRS/CRRN/COHN certifications are advantageous.

Responsibilities

• Prioritize and manage an assigned caseload of medical and disability workers compensation claims.
• Perform utilization review (UR) and telephonic case management as indicated.
• Communicate with injured employees, medical professionals, claims staff and employers to obtain information for medical assessments.
• Assess injury severity, disability, treatment plans, functional abilities and physical job requirements.
• Establish target return-to-work plans and strategies to manage future medical exposure.
• Direct treatment to appropriate panel and network providers.
• Negotiate treatment plans in compliance with Labor Code statutes and company standards.
• Manage external field case managers, vendors, UR/peer review and medical director resources.
• Respond to inquiries regarding case status.
• Document interventions, rationale and recommendations in the Zenith system.
• Facilitate return-to-work release and coordinate return-to-work efforts.
• Facilitate Maximum Medical Improvement and discharge from care.
• Educate claims staff, employers and Zenith staff on medical issues and guidelines.
• Perform other duties and projects as assigned.

Skills

Communication skills

Negotiation skills

Bilingual Spanish

Computer skills

Education

RN license

High School Diploma

Bachelor’s degree

CCM

CDMS

CIRS

CRRN

COHN

Tools

Microsoft Outlook

Microsoft Office

Job description

Jobtailor is seeking an experienced Registered Nurse to manage a case load of medical and disability workers’ compensation claims in California. The role emphasizes utilization review, telephonic case management, and collaboration with medical professionals and employers.

You will assess injury severity, develop treatment and return-to-work plans, and ensure compliance with Labor Code and company standards while coordinating with panel providers and external resources.