Telephonic/Field Nurse Case Manager

Encompass Health Solutions, Inc.•Burlingame, CA

8d•Remote

About The Position

The Telephonic/Field Nurse Case Manager is responsible for coordinating medical care and facilitating recovery for injured employees throughout the California workers' compensation process by providing a combination of telephonic and field case management services. While this position primarily manages cases through telephonic communication, field visits may be conducted as clinically appropriate, requested by the client, or required to support business and operational needs. The Nurse Case Manager serves as the clinical liaison among injured workers, employers, treating providers, claims professionals, attorneys, and the clients who engage Encompass Workers' Comp Solutions to provide objective workers' compensation case management services. Through proactive care coordination, professional communication, and sound clinical judgment, the Nurse Case Manager facilitates appropriate medical treatment, identifies barriers to recovery, promotes collaboration among stakeholders, and supports timely, safe return-to-work outcomes. This position requires exceptional communication skills, independent decision-making, professional documentation, and the flexibility to determine the most appropriate method of case management based upon the unique needs of each claim.

Requirements

Active, unrestricted California Registered Nurse (RN) license required.
Must be physically located within California.
Thorough understanding of California Workers' Compensation regulations and medical case management practices.
Strong clinical assessment, critical thinking, and problem-solving abilities.
Excellent written, verbal, and interpersonal communication skills.
Ability to independently manage a caseload utilizing both telephonic and field case management services.
High proficiency with Microsoft Office Suite, web-based systems, virtual communication platforms, and electronic case management systems.
Reliable high-speed internet connection and dedicated home office workspace.
Valid California driver's license, reliable transportation, and automobile insurance meeting company requirements.
Ability to travel throughout the assigned geographic territory as business needs require.

Nice To Haves

Minimum of three (3) years of workers' compensation case management experience preferred.
Certified Case Manager (CCM)
Certified Disability Management Specialist (CDMS)
Bilingual

Responsibilities

Manage an assigned caseload of California workers' compensation claims utilizing both telephonic and field case management services.
Conduct comprehensive clinical assessments through telephonic communication and in-person visits as appropriate.
Attend physician appointments, hospital visits, employer meetings, therapy appointments, and job site evaluations when clinically appropriate or requested.
Review medical records, treatment plans, diagnostic studies, work restrictions, and functional abilities.
Monitor treatment progress and identify barriers impacting medical recovery.
Coordinate referrals, diagnostic testing, specialty consultations, durable medical equipment, and other medically necessary services.
Support timely and appropriate return-to-work planning in collaboration with employers and treating providers.
Maintain regular communication with injured workers through telephonic contact and in-person meetings as appropriate.
Collaborate with treating physicians, employers, claims professionals, attorneys, rehabilitation providers, and other stakeholders.
Serve as an objective clinical resource while maintaining professional neutrality throughout the claim.
Communicate significant clinical findings, treatment concerns, and barriers to recovery in a timely manner.
Facilitate communication among all stakeholders to promote informed decision-making and positive claim outcomes.
Participate in interdisciplinary case conferences, client meetings, and provider discussions as appropriate.
Prepare timely, objective, accurate, and professional case management reports following company and client requirements.
Maintain complete and accurate documentation within the electronic case management system.
Ensure reports and documentation are completed within established company timelines.
Maintain compliance with California Workers' Compensation regulations, HIPAA requirements, URAC standards, client-specific guidelines, and company policies.
Protect confidential medical and claim information at all times.
Effectively manage caseload priorities, travel schedules, documentation deadlines, and follow-up activities.
Determine the most appropriate case management approach based upon clinical needs, client expectations, and operational requirements.
Maintain professional relationships with clients, providers, employers, and internal staff.
Participate in department meetings, continuing education, quality improvement initiatives, and company training.
Maintain current nursing licensure and any required certifications.
Perform other duties as assigned consistent with the nature of the position.