Schedule: Full time
Shift: Day (United States of America)
Address: 900 HOPE WAY
City: ALTAMONTE SPRINGS
State: Florida
Postal Code: 32714
Job Description:A Telephonic Nurse Case Manager provides telephonic medical case management for workers' compensation injury cases. The role involves independent assessment, planning, coordination, and advocacy to meet the injured worker's health needs using effective communication and evidence-based resources. This process supports optimal physical, psychosocial, and vocational outcomes while facilitating timely, cost-effective, and clinically appropriate care. The ideal candidate is committed to long-term professional growth and development within a high-performing workers' compensation case management program.
- Provide independent telephonic case management for a multi-state workers' compensation caseload, adhering to applicable jurisdictional requirements
- Reports directly to the Clinical Manager and independently manages workers' compensation cases, demonstrating sound clinical and claim-based decision-making.
- Apply the nursing process (assessment, planning, implementation, coordination, monitoring, evaluation) in accordance with case management standards
- Complete timely two-point initial contact within 48 hours, including injured worker assessment and provider verification; escalate high-risk cases appropriately
- Develop, implement, and proactively manage individualized treatment plans to ensure timely, appropriate, and cost-effective care
- Coordinate medical services, including therapy, diagnostics, DME, and ancillary services to support recovery and compliance
- Educate and guide injured workers on diagnosis, treatment plans, recovery expectations, and return-to-work goals
- Monitor medical progress through ongoing communication with providers and comprehensive medical record review, and timely coordination of care
- Identify barriers to recovery and implement solutions to mitigate delays and improve outcomes
- Evaluate treatment plans, medical necessity, and causation; coordinate and facilitate utilization review (UR), IMEs, and peer review as needed
- Manage medication oversight, reconciliation, safety, and appropriateness
- Drive timely and safe return-to-work planning in collaboration with employers and stakeholders
- Participate in case reviews, strategy roundtable discussions; collaborate with adjusters, legal teams, and departmental leadership to support optimal claim outcomes
- Maintain accurate, timely, and compliant documentation in all required systems; ensure regulatory and policy adherence
- Performs other duties as assigned
Knowledge, Skills, and Abilities: - Strong working knowledge of workers' compensation case management, injury care, and treatment protocols [Required]
- Demonstrated clinical assessment, critical thinking, and independent decision-making skills [Required]
- Proficient in Microsoft Office and case management systems [Required]
- Excellent verbal, written, and interpersonal communication skills across multidisciplinary teams [Required]
- Strong organizational skills and attention to detail in medical documentation and case management activities [Required]
- Ability to manage multiple cases independently in a fast-paced, deadline-driven environment [Required]
- Ability to adapt in a high-pressure environment while maintaining quality and compliance [Required]
- Ability to perform sedentary work, including prolonged sitting and computer use [Required]
- Strong knowledge of workers' compensation processes, regulations, and case management practices [Required]
- Understanding of medical terminology, clinical care, and evidence-based treatment protocols [Required]
- Ability to interpret complex medical records and apply clinical judgment to support workers' compensation case management and treatment planning [Required]
- Knowledge of injury management, disability management, and return-to-work principles [Required]
- Understanding of medical necessity, causation, and appropriate treatment planning [Required]
- Knowledge of documentation standards, confidentiality, and regulatory compliance (e.g., HIPAA) [Required]
- Effective professional communication skills for interaction with providers, adjusters, and injured workers, and leadership [Required]
- Knowledge of Epic electronic medical record (EMR) system [Preferred]
- Knowledge of evidence-based treatment guidelines (e.g., ODG -Official Disability Guidelines) and workers' compensation clinical review processes, including utilization review (UR), independent medical examinations (IMEs), and peer review principles [Preferred]
- Understanding of workers' compensation cost-containment strategies, including medical cost projections and resource utilization [Preferred]
Education: - Associate's of Nursing [Required]
- Bachelor's of Nursing [Preferred]
Field of Study: Work Experience: - 1+ year of telephonic or field workers' compensation case management experience, including medical coordination and return-to-work planning [Required]
- Experience interpreting medical records and coordinating medically appropriate treatment plans within workers' compensation [Required]
- Proven ability to manage cases and make sound clinical and claim-related decisions [Required]
- Experience managing complex or high-risk workers' compensation claims [Preferred]
- Experience collaborating with multidisciplinary teams, including adjusters, providers, and legal representatives [Preferred]
Additional Information: - Ability to obtain a compact nursing license upon hire [Required]
Licenses and Certifications: - Registered Nurse (RN) [Required]
- Certified Case Manager (CCM) [Preferred]
Physical Requirements: (Please click the link below to view work requirements)
Physical Requirements - https://tinyurl.com/23km2677
Pay Range:$68,132.50 - $119,520.35
