Nurse Medical Case Manager - Workers Compensation

Provide office-based telephonic medical case management for Workers Compensation claims. Focus on early intervention, coordinating quality medical care, supporting return to work planning, and ensuring appropriate treatment decisions aligned to jurisdictional guidelines and claim handling requirements.

• Contact customers, medical providers, and injured parties to coordinate medical care and return to work
• Develop strategies and update treatment and return to work plans within established protocols
• Evaluate medical treatment requests as reasonable and necessary per jurisdictional guidelines
• Engage specialty resources as needed including Dial-a-doc, physician advisor, peer reviews, MCU
• Submit accurate billing documentation and manage claim activities in Claim Platform Systems

Operational focus on case management workflow: managing treatment and return to work plans, evaluating medical treatment requests (reasonable and necessary), coordinating specialty resources (Dial-a-doc, physician advisor, peer reviews, MCU), and using internal Claim Platform Systems. Applies Preferred Provider Network rules per jurisdictional guidelines and supports claim decisioning by providing medical information and disability status.

The ideal candidate is a Nurse Medical Case Manager experienced in telephonic medical case management for Workers Compensation disability and medical treatment claims. They can coordinate medical care, drive early intervention and return to work planning, evaluate treatment requests against jurisdictional guidelines, and accurately document billing and claim activity in internal claim systems.