Triage Telephonic Nurse Case Manager

Department: Claims Administration & Adjusting

Employment Type: Permanent - Full Time

Location: Home United States

Reporting To: Shaunna Jones

Compensation: $66,000 - $67,000 / year

Description

Key Responsibilities

• Conduct initial triage and telephonic case management at the outset of Workers’ Compensation claims.
• Perform clinical assessments of injured workers to determine appropriate medical care and treatment pathways.
• Complete initial assessment and required three-point contact in accordance with State of Florida procedures and emergency protocols.
• Develop an initial case management care plan based on clinical findings and information obtained from the injured worker, employer, and medical provider.
• Identify potential causation concerns or barriers to recovery and document findings appropriately.
• Facilitate communication between injured workers, employers, claims professionals, healthcare providers, and rehabilitation specialists.
• Monitor treatment plans to ensure adherence to state-mandated treatment guidelines and evidence-based medical protocols.
• Address initial return-to-work capabilities with injured workers and providers, documenting updates in the case management system.
• Maintain accurate and timely documentation of all contacts, interviews, and medical information in the claims management system.
• Identify opportunities for cost-effective medical management and appropriate utilization of services.
• Educate injured workers and their families about recovery expectations and care plans.
• Maintain strict patient confidentiality and compliance with state and federal healthcare regulations.
• Serve as a patient advocate, ensuring quality care and adherence to ethical and regulatory standards.
• Participate in quality assurance initiatives, committees, and department activities as required.
• Assist with training claims staff on identifying medical case management opportunities, as needed.

Skills, knowledge & expertise

• Registered Nurse (RN) with an active and unrestricted state license
• Minimum of 3 years of clinical nursing experience (medical-surgical, orthopedic, neurological, ICU/CCU, occupational health, or related specialty).
• Workers’ Compensation case management experience preferred.
• Prior telephonic case management or triage experience preferred.
• Strong understanding of clinical documentation and patient advocacy principles.
• Strong clinical assessment and triage skills in a Workers’ Compensation or occupational health environment.
• Knowledge of Workers’ Compensation medical case management practices and treatment guidelines.
• Ability to identify barriers to recovery and develop appropriate care strategies.
• Excellent verbal and written communication skills, with the ability to work collaboratively with multiple stakeholders.
• Strong organizational and documentation skills with attention to detail.
• Ability to work independently and manage multiple priorities in a fast-paced environment.
• Proficiency with computer systems, case management software, and Microsoft Office applications.
• Commitment to high-quality patient care, confidentiality, and regulatory compliance.

Benefits

• Medical, dental, and vision plans to ensure your health and that of your family.
• A 401k plan with employer matching to help you build a secure financial future.
• Our time-off policies, including Discretionary Time Off (DTO) for exempt employees and Paid Time Off (PTO) package for non-exempt employees, reflect our commitment to promoting a healthy work environment.
• Paid holidays.
• Life insurance and both short-term and long-term disability plans, providing essential financial protection for you and your loved ones.