Nurse Case Manager (Worker's Compensation)

Position Summary

Regularly exercises independent discretion and judgment in the coordination and management of the medical and disability process. Provides medical and rehabilitation consultation and education to claims personnel.

What You’ll Do

As a Nurse Case Manager supporting Workers’ Compensation claims, you’ll use your clinical expertise and independent judgment to guide injured workers through the medical and disability process. You’ll collaborate closely with claims professionals, medical providers, employers, and injured employees to ensure treatment plans are appropriate, cost-effective, and aligned with recovery goals. From evaluating care plans and disability timelines to facilitating safe return-to-work outcomes, you’ll play a key role in driving strong claim results while advocating for quality care. This is a remote, Monday through Friday position — no weekends — designed for a nurse who thrives in an autonomous, fast-paced environment and is confident managing their own caseload.

Location: Will work remote from home and ideally based in North Carolina (strongly preferred) or Virginia. Candidates within Erie’s operational footprint will also be considered.

• All Employees that work remotely must have access to internet service bandwidth speeds that meet ERIE’s requirement of 50 mbps download and 10 mbps upload.  

What Makes You Stand Out

• Active, unrestricted RN license
• Certified Case Manager (CCM) designation — or willingness to obtain (required for handling North Carolina Workers’ Compensation claims)
• Experience in Workers’ Compensation case management
• Strong clinical background, especially in Critical Care, ER, ICU, Trauma, Orthopedics, or Neurosurgery
• Ability to work independently and manage claims with sound clinical judgment
• Exceptional written communication skills — documentation and clarity matter
• Bilingual skills

Duties and Responsibilities

• Coordinates the injured workers' medical treatment to ensure both cost effective and medically appropriate care is provided.
• Identifies inappropriate, experimental, overutilization or costly medical treatment.
• Facilitates the return to work process by acting as a liaison between the insured, medical provider, injured worker and the claims handler. Prepares job analyses and obtains medical clearance for return to work.
• Provides the claims handler with appropriate disability timeframes through the utilization of the Official Disability Guidelines.
• Coordinates treatment plans for cases involving catastrophic injuries and complicated medical conditions.
• Questions the causal relationship between the treatment and injury claimed.
• Assists in identifying and evaluating providers and managed care vendors.
• Oversees Vocational Rehabilitation activities in collaboration with the claims handlers.
• Proactively manages and controls expenses through utilization of Erie's cost containment vendors.
• Prepares medical cost projections and makes reserve recommendations upon request.
• Provides medical education and guidance to claims handlers on complex files.
• Maintains current knowledge of medical and rehabilitation trends.

The first six duties listed are the functions identified as essential to the job. Essential functions are those job duties that must be performed in order for the job to be accomplished.

This position description in no way states or implies that these are the only duties to be performed by the incumbent. Employees are required to follow any other job-related instruction and to perform any other duties as requested by their supervisor, or as become evident.

Capabilities

Qualifications

Minimum Educational Requirements

• High school diploma, or GED, required.
• Current unrestricted Registered Nurse (RN) license in the state where the position is based and other assigned states as required by law.
• Bachelor of Science in Nursing (B.S.N.) and Certified Case Manager (C.C.M.) preferred.

Additional Experience

• Three years experience in case management involving workers' compensation claims preferred.
• Five years clinical nurse experience with a preference for previous Orthopedic, Emergency Room, or Critical Care experience preferred.
• Incumbent must live in region assigned unless a change is approved by the company.

Designations and/or Licenses

• Valid driver's license and good driving record required.

Physical Requirements