Nurse Case Manager, Workers Compensation

Job Description

Location: Remote (US-based)

We are seeking a Nurse Case Manager, Workers Compensation to manage occupational injury claims from referral through return to work for a national managed care organization serving self-insured employers, insurers, and third-party administrators. This position is a full-time, direct hire opportunity available fully remote within the United States.

This role is best aligned for an RN who wants to apply clinical judgment to disability outcomes rather than bedside care. You will carry an active caseload, drive treatment plans against evidence-based guidelines, coordinate authorizations, and work directly with employers to build modified duty that gets injured workers back on the job safely. The ideal candidate is comfortable holding the center between adjusters, physicians, employers, and counsel, and knows how to move a stalled claim.

Responsibilities:

• Manage 60 to 90 active workers compensation claims from injury referral through return to work or maximum medical improvement
• Conduct assessments evaluating functional capacity, psychosocial barriers, treatment compliance, and return-to-work readiness
• Develop individualized case plans in collaboration with physicians, specialists, therapists, and vocational rehabilitation consultants
• Review medical records and treatment plans against evidence-based guidelines to identify care gaps and treatment delays
• Facilitate independent medical examinations and functional capacity evaluations, synthesizing findings into case strategy recommendations
• Coordinate authorizations for specialist referrals, surgery, durable medical equipment, home health, and pharmacy management
• Partner with employers to develop modified duty, transitional work, and return-to-work programs aligned to actual job functions
• Serve as the primary liaison between injured workers, adjusters, employers, counsel, and treating providers
• Identify psychosocial and cultural barriers to recovery and connect injured workers with behavioral health and support resources
• Document case activity and outcomes in the claims management platform within required turnaround standards

Qualifications:

• ADN required; BSN preferred
• Active, unrestricted RN license required; multi-state compact licensure or willingness to obtain additional state licenses required
• Minimum of 3 years of clinical nursing experience required
• Minimum of 2 years of workers compensation case management experience, telephonic or field, required
• CCM, CRRN, or COHN certification preferred, with CCM strongly preferred
• Clinical background in orthopedics, occupational health, rehabilitation, emergency medicine, or neurology preferred
• Working knowledge of multi-state workers compensation jurisdictions, ODG or ACOEM guidelines, and return-to-work program design
• Experience with claims management platforms such as Juris, Guidewire, or Majesco preferred
• Strong negotiation, documentation, and stakeholder communication skills

Schedule:

• Full-time position, Monday through Friday
• Fully remote within the United States
• Standard business hours with schedule flexibility

Salary Range: The salary range for this position is approximately $75,000 – $92,000 annually ($36.06 – $44.23 per hour), based on experience and qualifications.

Interview Process:

• Selected candidates will participate in a multi-step interview process, including an initial screening with TalentLNX followed by interviews with department leadership.

Equal Opportunity Employer: TalentLNX is committed to equal employment opportunity and a diverse, inclusive workforce. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status.