HR Clinical Case Manager

Aston Carter•Springfield, IL

6d•$30 - $33•Remote

About The Position

The HR Clinical Case Manager supports a Disability Leave Service organization by providing expert clinical consultation on complex disability, leave, and accommodation cases. This role combines strong medical acumen with compassionate, business-focused case management to help employees successfully return to work while supporting organizational goals. You will review claims from a clinical perspective, partner closely with disability case managers, appeals consultants, and accommodation specialists, and translate medical information into clear, actionable recommendations.

Requirements

Current Registered Nurse (RN) license or Bachelor of Science in Nursing (BSN) required.
Minimum of 3 years of direct clinical work experience.
Minimum of 3 years of clinical experience in any setting, with hands-on inpatient experience strongly beneficial.
Strong medical acumen with the ability to understand and interpret medical diagnoses, ICD-10 codes, and their impact on functional capacity.
Demonstrated clinical case management skills, including evaluating medical documentation and applying clinical criteria.
Ability to exercise sound critical thinking and problem-solving skills with minimal guidance.
Exceptional written and verbal communication skills, with the ability to confidently communicate with physicians and all levels of an employee’s treating provider team.
Proven ability to work cross-functionally and collaborate with multiple stakeholder groups with varying levels of clinical knowledge.
Strong organizational skills, attention to detail, and the ability to prioritize in a fast-paced environment.
Ability to utilize clinical judgment in decision-making regarding disability claims and return-to-work recommendations.

Nice To Haves

3+ years of experience in the disability management industry managing short-term disability (STD) or long-term disability (LTD) claims.
Experience in disability management, case management, or workers’ compensation is a strong plus.
Understanding of regulations under FMLA, ADAAA, EEOC, OFCCP, and various state and local leave of absence laws.
Utilization review experience and/or experience using specific clinical criteria or protocols.
Experience navigating large organizations and engaging multiple stakeholder groups.
Experience with third-party administrators or similar environments is beneficial.
Certification as a Certified Case Manager (CCM) or Certified Disability Management Specialist (CDMS) preferred.
Strong interpersonal skills with a desire to share knowledge and support continuous learning within the team.
Ability to balance compassionate employee support with business-focused case consultation.

Responsibilities

Manage a caseload of approximately 50–60 cases per month, including 17–25 active short-term disability claims at any given time.
Perform clinical claim reviews to evaluate medical documentation against established parameters and clinical criteria.
Provide medical evaluations and clinical guidance to Disability Leave Service operations and the appeals unit.
Serve as a clinical subject matter expert to disability case managers, offering analyses related to functional impairment, work capacity, and return-to-work readiness.
Conduct peer clinical and appeal case consultations with treating providers to gain insight into medical restrictions and limitations, determine levels of functional capacity, and assist in developing return-to-work plans.
Communicate directly with healthcare providers to gather additional information, clarify medical records, and assess whether functional impairments prevent employees from performing essential job functions.
Determine whether disability claims are supported for specific durations based on medical documentation and clinical judgment.
Escalate cases for clinical review when medical documentation exceeds standard guidelines and coordinate with clinicians by submitting cases into the clinical review queue.
Utilize sound clinical judgment, critical thinking, and problem-solving skills to make timely, well-supported decisions.
Collaborate with case managers, clinicians, operations, appeals, and vendor teams through established internal channels to ensure timely support, guidance, and case resolution.
Provide continuing education and clinical guidance for case management staff to strengthen their understanding of medical issues impacting disability and accommodations.
Assist in the creation of an integrated clinical management model in partnership with operations, appeals, and vendor teams.
Support the development of clinical tools, templates, processes, and protocols under the direction of the clinical leadership team.
Apply knowledge of medical diagnoses, ICD-10 codes, and functional impacts to evaluate how health conditions affect employees’ ability to perform essential job duties.
Translate clinical expertise into practical consultations that support both employees and the organization in achieving successful return-to-work outcomes.
Exercise strong self-management skills by organizing workload, prioritizing tasks, and maintaining attention to detail in a fast-paced environment.
Re-engage with cases only when new tasks are generated, ensuring efficient workflow management.
Provide guidance to operations teams on clinical aspects of disability, leave, and accommodations.
Travel domestically and internationally up to 30% as needed to support clinical case management activities and stakeholder engagement.