Senior Nurse Case Manager Hybrid Field Leader

AF Group Careers Section; Chicago (IL); Hybrid; USD 74,000 - 123,000; Full time

Job summary

AF Group seeks a Senior Nurse Case Manager to support the Claims Department by reviewing complex workers’ compensation claims, determining medical necessity, facilitating return to work, and leading cost-containment initiatives. This role may operate telephonically or as a Field NCM providing in-person care.

The Field SNCM Manager will work on-site with injured workers, providers, and employers to ensure timely care and recovery, with a hybrid schedule and travel as needed.

Qualifications

• Five (5) years of progressive responsibility in injury case management.
• Three (3) years of active RN clinical experience.
• Three (3) years of workers’ compensation case management or related field.
• Field Case Manager experience preferred.

Responsibilities

• Oversee new assignments and initial contacts with all parties.
• Review clinical status to assess causality and treatment need.
• Complete RN templates with medical history and cost drivers.
• Negotiate and coordinate early return to work or alternative duty.
• Oversee external NCM tasks and document POA with timelines.
• Apply medical knowledge during physician/therapist contacts.
• Determine medical necessity and hospital admission status.
• Conduct case research and coordinate with stakeholders.
• Refer cases not meeting criteria to medical director.
• Prepare correspondence and communicate decisions to teams.
• Manage claims across multiple jurisdictions.
• Close assignments per performance standards.
• Train and mentor junior nurse case managers.
• Prepare professional presentations for customers.
• Assist manager with monthly NCM outcomes and quality assessments.

Skills

RN license

Leadership

Negotiation

Communication

Clinical knowledge

Microsoft Windows

Education

Registered Nurse (RN) license

BSN preferred

Job description

AF Group seeks a Senior Nurse Case Manager to support the Claims Department by reviewing complex workers’ compensation claims, determining medical necessity, facilitating return to work, and leading cost-containment initiatives. This role may operate telephonically or as a Field NCM providing in-person care.

The Field SNCM Manager will work on-site with injured workers, providers, and employers to ensure timely care and recovery, with a hybrid schedule and travel as needed.