Telephonic Case Manager

Sedgwick

1d•$70,000 - $78,000•Remote

About The Position

While partnering with the injured worker, employer, and medical providers, the Telephonic Case Manager creates a case management strategy to facilitate medical recovery and a successful return to work through advocacy, communication, and coordination of medical services. The role applies medical, clinical, or rehabilitation knowledge to help manage complex medical conditions, treatment planning, and recovery from illness or injury. It is a remote position offering flexibility and autonomy while advocating for effective and efficient medical treatment for injured employees.

Requirements

Current unrestricted RN license in a state or territory of the United States.

Nice To Haves

Bachelor’s degree in nursing (BSN) from an accredited college or university, or equivalent work experience.
Certification in case management, rehabilitation nursing, or a related specialty.

Responsibilities

Perform initial and ongoing clinical assessments by telephone to evaluate the injured worker’s injury, medical treatment, psychosocial needs, cultural implications, and support systems.
Communicate effectively and build relationships with the claims examiner, client, injured worker, attorney, and supervisor.
Identify issues related to delayed recovery or return to work and solve problems creatively.
Negotiate treatment and disability duration with providers using medical and disability duration guidelines while adhering to quality standards.
Identify opportunities to expedite care for cost containment and timely medical recovery.
Recommend alternate clinical resources to support claim resolution.
Maintain client privacy and confidentiality, promote client safety and advocacy, and adhere to ethical, legal, accreditation, and regulatory standards.