Senior Nurse Case Manager — Hybrid/Remote Claims Strategy

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

Job summary

AF - Group is seeking a Senior Nurse Case Manager to support the Claims Department in reviewing complex workers’ compensation claims, determining medical necessity, and facilitating return to work. This role may operate telephonically or as a Field NCM, providing care coordination and guidance to injured employees, providers, and employers.

You will lead medical cost containment initiatives, mentor junior staff, and develop proactive strategies across multiple jurisdictions.

Qualifications

• Registered Nurse license active and unrestricted required.
• Bachelor’s degree in nursing (BSN) preferred.

Responsibilities

• Oversee new assignments and make timely initial contacts with all parties.
• Review patient clinical status and history to determine casual nature of symptoms related to work injuries.
• Document and negotiate with employers for early return to work or alternative duties.
• Coordinate with external nurse case management and document cost-benefit of assignments.
• Apply medical knowledge to assess medical necessity and appropriate level of care.
• Mentor and train nurse case managers with less experience.

Skills

RN experience

Case management

Negotiation

Communication

Leadership

Education

RN license

BSN preferred

Tools

Microsoft Windows

Job description

AF - Group is seeking a Senior Nurse Case Manager to support the Claims Department in reviewing complex workers’ compensation claims, determining medical necessity, and facilitating return to work. This role may operate telephonically or as a Field NCM, providing care coordination and guidance to injured employees, providers, and employers.

You will lead medical cost containment initiatives, mentor junior staff, and develop proactive strategies across multiple jurisdictions.