Manager,TelephonicNurseCaseManagement

Manager, Telephonic Nurse Case Management **Job Purpose** The Nurse Case Manager serves as the clinical resource within the Risk Management & Safety team, providing telephonic nurse case management to support injured employees through the workers' compensation process from initial injury through return to work. This role applies clinical expertise to evaluate the appropriateness of medical treatment, facilitate timely access to quality care, coordinate return-to-work planning, and drive optimal outcomes for both the injured employee and the organization. The Nurse Case Manager works collaboratively with treating physicians, the Third Party Administrator (TPA), adjusters, legal counsel, managers, and HR to ensure claims progress efficiently, medical costs are appropriate, and injured employees are supported throughout recovery. This position requires a current Registered Nurse license with multistate compact privileges, strong clinical judgment, and deep familiarity with workers' compensation medical management across multiple jurisdictions. **Duties & Responsibilities** * Provide telephonic nurse case management on new and open workers' compensation claims, within established timeframes. * Evaluate the nature and severity of injuries, review medical documentation, and assess treatment plans for clinical appropriateness, necessity, and alignment with evidence-based treatment guidelines (e.g., ODG, ACOEM, state-specific guidelines). * Identify claims requiring nurse case management intervention based on clinical red flags, including delayed recovery, comorbidities, complex diagnoses, surgical recommendations, opioid prescriptions, and psychosocial barriers to return to work. * Maintain ongoing communication with injured employees to monitor recovery progress, address concerns, reinforce compliance with treatment plans, and provide education on their condition and the recovery process. * Coordinate with treating physicians to clarify diagnoses, discuss treatment plans,