Telephonic Nurse Case Manager (Remote)

We are seeking a Telephonic Nurse Case Manager to join our team. As a Telephonic Nurse Case Manager, you will be responsible for managing and making independent decisions on medical claims. You will monitor, analyze, evaluate, and coordinate the delivery of high-quality, timely, and cost-effective medical treatment and other health services as needed by an injured employee to promote an appropriate and prompt return to work when medically indicated.

Key responsibilities include:

• Coordinating and monitoring medical treatment for injured workers involved in workers’ compensation claims.
• Reviewing medical records, treatment plans, and diagnostic reports to assess the appropriateness of care.
• Providing clinical recommendations regarding treatment plans, medical progress, and anticipated recovery timelines.
• Communicating with treating physicians and medical providers to clarify treatment plans and facilitate appropriate care.
• Partnering closely with claims adjusters to provide clinical insight that supports claim evaluation and resolution.

You will perform telephonic case-management activities on workers’ compensation cases according to parameters identified and required performance standards per the State of Florida.