[Hiring] Manager, Telephonic Nurse Case Management @Panera Bread

Role Description

The Nurse Case Manager serves as the clinical resource within the Risk Management & Safety team, providing telephonic nurse case management to support injured employees through the workers' compensation process from initial injury through return to work. This role applies clinical expertise to evaluate the appropriateness of medical treatment, facilitate timely access to quality care, coordinate return-to-work planning, and drive optimal outcomes for both the injured employee and the organization.

• Provide telephonic nurse case management on new and open workers' compensation claims, within established timeframes.
• Evaluate the nature and severity of injuries, review medical documentation, and assess treatment plans for clinical appropriateness, necessity, and alignment with evidence-based treatment guidelines (e.g., ODG, ACOEM, state-specific guidelines).
• Identify claims requiring nurse case management intervention based on clinical red flags, including delayed recovery, comorbidities, complex diagnoses, surgical recommendations, opioid prescriptions, and psychosocial barriers to return to work.
• Maintain ongoing communication with injured employees to monitor recovery progress, address concerns, reinforce compliance with treatment plans, and provide education on their condition and the recovery process.
• Coordinate with treating physicians to clarify diagnoses, discuss treatment plans, obtain functional capacity information, and advocate for appropriate work restrictions and modified duty accommodations.
• Facilitate peer-to-peer and utilization review referrals when treatment appears outside established guidelines, and work with the TPA and UR vendor to manage the process.
• Identify and escalate potential fraud indicators, secondary gain issues, or malingering concerns to the adjuster and Risk Management leadership with supporting clinical documentation.

Qualifications

• Active, unrestricted Registered Nurse (RN) license in good standing.
• Nurse Licensure Compact (NLC) multistate license required.
• Certified Case Manager (CCM) required.
• 5+ years of clinical nursing experience, with a minimum of 3 years in workers' compensation nurse case management.
• Demonstrated experience managing a caseload of workers' compensation claims across multiple jurisdictions.
• Experience with telephonic nurse case management, including three-point contact, treatment plan review, return-to-work coordination, and utilization management.
• Familiarity with evidence-based treatment guidelines (ODG, ACOEM, or state-specific guidelines).
• Experience working with TPAs, insurance carriers, and/or self-insured employers in a workers' compensation environment.
• Knowledge of workers' compensation regulatory frameworks across multiple states.
• Experience with claims management systems (RMIS or TPA platforms).

Requirements

• Strong clinical assessment and critical thinking skills.
• Exceptional verbal and written communication skills.
• Empathetic, employee-centered approach balanced with cost-consciousness.
• Ability to manage a high-volume caseload independently.
• Strong organizational skills with meticulous attention to documentation quality.
• Collaborative approach with the ability to build productive working relationships.
• Proficiency with Microsoft Office (Excel, Word, Outlook, Teams).
• High level of professional integrity and discretion when handling confidential information.

Benefits

• Competitive Pay: $87,753 to $103,239 annually.
• The actual pay offered will be determined by multiple factors, including but not limited to the candidate’s relevant experience, job-related knowledge, skills, and geographical location.

Working Conditions

• Fully remote position; must maintain a dedicated, professional home office environment with reliable high-speed internet.
• Must reside in a Nurse Licensure Compact (NLC) state to maintain multistate practice privileges.
• Caseload volume and complexity may fluctuate; ability to manage workload during peak injury periods is essential.