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Making Numbers Make Sense
RN Telephonic Nurse Case Manager
Location
Alabama
Posted
112 days ago
Salary
$80K - $85K / year
Seniority
Senior
Job Description
RN Telephonic Nurse Case Manager
MDD Forensic Accountants
• Provide telephonic case management for Workers’ Compensation cases. • Assess medical appropriateness of treatment plans and coordinate services to optimize recovery and cost efficiency. • Develop, implement, and modify individualized case management care plans. • Perform ongoing clinical assessments and review medical records to ensure quality and timely care. • Identify and address barriers to recovery with proactive action planning. • Coordinate communication between injured workers, employers, providers, insurers, and other stakeholders. • Promote and document return-to-work capability at each medical milestone. • Ensure compliance with state-mandated treatment guidelines, nationally published protocols, and client requirements. • Track outcomes including patient satisfaction, return-to-work progress, and disability duration. • Utilize utilization review tools when indicated (pre-certification, concurrent review, retrospective review, medical director review). • Monitor provider and vendor performance to ensure quality and appropriate care delivery. • Maintain detailed and accurate documentation within the case management system. • Serve as a patient advocate while adhering to all legal, ethical, accreditation, and regulatory standards. • Participate in Quality Assurance, Grievance, or other committees as assigned. • Provide training or mentorship to claims staff or junior team members as appropriate. • Perform additional duties as assigned.
Job Requirements
- Active, unrestricted RN license.
- Minimum 3 years of clinical experience (medical-surgical, orthopedic, neurological, ICCU, industrial, ER, or occupational health).
- Workers’ Compensation case management experience preferred.
- Strong knowledge of treatment guidelines and utilization management principles.
- Excellent verbal and written communication skills.
- Ability to work independently in a remote environment.
- Proficiency in computer systems and claims/case management software.
- Telephonic case management experience.
- Experience applying evidence-based disability duration guidelines.
- Prior experience training or mentoring staff.
Benefits
- Medical, dental, and vision plans to ensure your health and that of your family.
- A 401k plan with employer matching to help you build a secure financial future.
- Our time-off policies, including Discretionary Time Off for exempt employees and Paid Time Off (PTO) package for non-exempt employees, reflect our commitment to promoting a healthy work environment.
- Paid holidays.
- Life insurance and both short-term and long-term disability plans, providing essential financial protection for you and your loved ones.
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