Telephonic Case Manager (California License Required) at TRIUNE Health Group Inc

Telephonic Case Manager (California License Required)

About TRIUNE Health Group TRIUNE Health Group is a nationally recognized managed healthcare company with over 35 years of experience. As a mission-driven, second-generation family-owned business, we are dedicated to improving lives by reducing the impact of injuries, enhancing health and wellness, and lowering healthcare and workers' compensation costs. At TRIUNE, we believe that every team member is essential to our success. We foster a supportive and collaborative environment where employees are valued, empowered, and provided with the tools they need to thrive-both professionally and personally. Why Join TRIUNE Health Group as a Nurse Case Manager?

• Be part of a well-established, family-owned company that prioritizes people over profits.
• Experience our culture of People Helping People , where every team member is treated with dignity and respect.
• Enjoy the stability, support, and resources needed to succeed while maintaining a healthy work-life balance.

Perks & Benefits:

• Generous Time Off: 20 days of vacation plus 8.5 paid holidays
• Retirement Savings: 401(k) match to help you plan for the future
• Comprehensive Insurance: Medical, dental, and vision coverage
• Disability Coverage: Short-Term (STD) and Long-Term Disability (LTD) insurance
• Employee Support: Employee Assistance and Referral Program
• Work-from-Home Essentials: Home office equipment, including a laptop and desktop monitor
• Travel Perks: Mileage and travel reimbursement

TRIUNE Health Group is an equal opportunity employer and a values-driven organization. Compensation is competitive and commensurate with experience. Summary of Position: Candidates do not need to reside in California; this position may be performed remotely from anywhere within the United States. The Telephonic Case Manager provides clinical case management services to injured or ill individuals primarily through telephonic and electronic communication. This role focuses on care coordination, treatment planning, patient education, and resource facilitation to promote quality outcomes, cost-effective care, and timely return to work when appropriate. Essential Duties and Responsibilities:

• Provide telephonic medical case management services through ongoing communication with injured workers, treating providers, employers, and referral sources
• Apply the core steps of Case Management, including assessment, planning, implementation, monitoring, and evaluation of care plans
• Review and evaluate treatment plans for medical necessity, appropriateness, and cost-effectiveness
• Coordinate care and services such as diagnostics, specialist referrals, durable medical equipment, and home health services as needed
• Communicate medical information clearly, professionally, and compassionately to patients and stakeholders
• Educate patients on diagnoses, treatment plans, recovery expectations, and return-to-work processes
• Identify barriers to recovery and collaborate with the care team to develop solutions
• Maintain timely, accurate, and well-organized documentation and reports in compliance with HIPAA and company standards
• Stay current on medical terminology and applicable federal and state regulations, including Workers' Compensation, ADA, HIPAA, FMLA, STD, LTD, SSDI, and SSA
• Utilize technology effectively, including case management systems, Microsoft Office applications, phone systems, and secure communication tools
• Research and recommend appropriate medical and community resources for individuals with acute, chronic, or catastrophic conditions
• Perform other duties as assigned

Job Qualifications: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Skills and Abilities:

• Strong clinical judgment and critical thinking skills
• Excellent verbal and written communication skills, with the ability to build rapport telephonically
• Highly organized, detail-oriented, and able to manage multiple cases simultaneously
• Ability to work independently while collaborating with a remote team
• Proficient in Microsoft Office Suite (Word, Excel, Outlook) and web-based systems
• Professional, empathetic, and solution-oriented approach to case management
• Dependable, adaptable, and comfortable in a fast-paced, remote environment

Education and Experience:

• Graduate of an accredited school of nursing.
• Current and active California RN license required.
• Candidates do not need to reside in California; this position may be performed remotely from anywhere within the United States.
• Fluency in English (speaking, reading, and writing).
• Three or more years of recent clinical experience, preferably in trauma, psychology, emergency, orthopedics, rehabilitation, occupational health, and neurology.
• CCM preferred.

Certificates, Licenses, Registrations: While not required, candidates with one or more of the following certifications are preferred:

• CCM
• COHN / COHN-S
• CDMS

Physical Demands: The physical demands described here are representative of those that must be met to successfully perform the essential functions of this role. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. This position is primarily sedentary and performed in a remote/home office environment. Compensation & Benefits Disclosure The base salary range/hourly rate is dependent on job-related, non-discriminatory factors such as experience, education, and skills. This position may be eligible for incentive compensation awards and a competitive benefits package, including medical, dental, vision, life, disability insurance, paid holidays, paid time off, and 401(k).

PIb5132c287fda-5667