Telephonic Medical Case Manager for Workers' Comp

Tristar Insurance; South Carolina; Hybrid; USD 65,000 - 85,000; Full time

Job summary

Tristar Insurance seeks a Medical Case Manager to deliver telephonic case management in a workers’ compensation setting, coordinating resources and cost-effective options to support individualized treatment goals and return-to-work placement.

Responsibilities include assessment, care planning, data review, and ongoing coordination with providers, claimants, and employers, while maintaining HIPAA compliance and high-quality documentation.

Qualifications

• RN/LPN/CCM license required or equivalent.
• Three+ years of clinical experience in acute care.
• Two+ years in medical case management or workers’ compensation.
• Knowledge of utilization management and cost control.
• Familiarity with discharge planning and QA processes.
• Strong problem solving, planning and negotiation skills.
• Proficient with MS Office applications.

Responsibilities

• Provide telephonic case management for workers’ compensation patients.
• Assess, plan, implement and coordinate care with all stakeholders.
• Document assessments and develop clinical case plans.
• Coordinate contact with providers, claimants and examiners.
• Review records, analyze data and determine care needs.
• Monitor appointments, address RTW and treatment plan issues.
• Maintain confidentiality per HIPAA and PHI regulations.

Education

RN/LPN/CCM license required

CCM/CPHM certifications preferred

Clinical experience in acute care

Medical case management experience

Utilization management knowledge

Quality improvement

Discharge planning

Cost management

Problem solving

Planning and organization

Negotiation and interpersonal skills

MS Office (Word, Excel, PowerPoint)

Job description

Tristar Insurance seeks a Medical Case Manager to deliver telephonic case management in a workers’ compensation setting, coordinating resources and cost-effective options to support individualized treatment goals and return-to-work placement.

Responsibilities include assessment, care planning, data review, and ongoing coordination with providers, claimants, and employers, while maintaining HIPAA compliance and high-quality documentation.