MDD Forensic Accountants logo
MDD Forensic Accountants

Making Numbers Make Sense

RN Telephonic Nurse Case Manager

ManagerManagerFull TimeRemoteSeniorTeam 201-500Since 1933H1B No SponsorCompany SiteLinkedIn

Location

Alabama

Posted

3 days ago

Salary

$75K - $80K / year

Seniority

Senior

Associate Degree3 yrs expEnglish

Job Description

RN Telephonic Nurse Case Manager

MDD Forensic Accountants

• Manage a caseload of Workers’ Compensation claims through telephonic case management services • Conduct comprehensive initial and ongoing assessments of injured employees’ medical status, treatment progress, and recovery needs • Develop, implement, and monitor individualized case management plans to promote optimal medical outcomes. • Review medical records, treatment recommendations, and clinical information to determine appropriateness of care. • Identify barriers to recovery and develop action plans to facilitate progress toward recovery and return-to-work goals. • Monitor adherence to evidence-based treatment guidelines, utilization criteria, and regulatory requirements. • Evaluate treatment plans and document clinical outcomes, recovery progress, and return-to-work milestones. • Act as a liaison among injured employees, employers, healthcare providers, insurers, attorneys, and other authorized stakeholders. • Facilitate effective communication to ensure alignment on treatment plans, recovery goals, and return-to-work expectations. • Establish and maintain strong client relationships through professional service and responsive communication. • Serve as a patient advocate while maintaining compliance with legal, ethical, and regulatory standards. • Address return-to-work capabilities with injured employees and treating providers during ongoing case reviews. • Collaborate with employers and providers to support transitional or modified duty opportunities when appropriate. • Obtain and review job descriptions to assist providers in evaluating work capacity and restrictions. • Promote timely and medically appropriate return-to-work outcomes. • Maintain accurate, timely, and comprehensive case documentation within designated systems. • Ensure compliance with state Workers’ Compensation regulations, client requirements, and company policies. • Protect confidential medical information in accordance with HIPAA and applicable privacy regulations. • Support utilization review processes, including pre-authorization, concurrent review, retrospective review, and medical director referrals as needed. • Monitor provider and vendor performance to ensure quality service delivery. • Identify opportunities for process improvement and operational efficiencies. • Participate in quality assurance, grievance, and other organizational committees as assigned. • Provide clinical education and support to internal staff and stakeholders when appropriate. • Assist with training, mentoring, or guidance of less experienced team members as requested. • Perform other duties as assigned.

Job Requirements

  • Minimum three (3) years of clinical nursing experience in one or more of the following areas:
  • Medical-Surgical
  • Orthopedics
  • Neurology
  • Critical Care/ICCU
  • Emergency Room
  • Occupational Health
  • Industrial Nursing
  • Workers’ Compensation case management experience preferred.
  • Telephonic case management experience preferred.
  • Current, unrestricted Registered Nurse (RN) license in the applicable state(s).
  • Ability to maintain active licensure throughout employment.
  • Strong clinical assessment and critical thinking skills.
  • Knowledge of Workers’ Compensation processes, regulations, and medical case management principles.
  • Understanding of evidence-based treatment guidelines and disability management practices.
  • Ability to manage multiple priorities independently in a fast-paced environment.
  • Strong organizational and time-management skills.
  • Excellent verbal and written communication skills.
  • Ability to build collaborative relationships with diverse stakeholders.
  • Strong customer service orientation and professionalism.
  • Proficiency with Microsoft Office applications and case management software systems.
  • Ability to maintain confidentiality and exercise sound clinical judgment.
  • Minimal travel may be required based on business needs.

Benefits

  • Medical, dental, and vision plans to support your health and that of your family
  • A 401(k) plan with employer matching
  • Time‑off policies, including Discretionary Time Off (DTO) for exempt employees and Paid Time Off (PTO) for non‑exempt employees
  • Paid holidays
  • Life insurance and short‑term and long‑term disability coverage
  • Paid sick leave, paid family and parental leave, and other mandated benefits in accordance with applicable state and local requirements

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