• Provide specialized telephonic case management for complex and catastrophic Workers’ Compensation claims • Direct injured employees to appropriate specialty care while maintaining a strong focus on cost containment • Monitor, analyze, and coordinate high-quality, timely, and cost-effective medical treatment • Perform comprehensive medical assessments and develop individualized, outcome-focused case management plans • Facilitate communication among injured workers, employers, adjusters, providers, insurers, and other stakeholders • Identify barriers to recovery and proactively develop strategies to address them • Monitor vendor performance and ensure quality delivery of medical services • Track, evaluate, and document treatment plans, outcomes, and recovery progress in the case management system • Assess and document return-to-work capabilities and identify modified or alternative duty options when appropriate • Manage cases in compliance with state-mandated treatment guidelines, utilization criteria, and evidence-based protocols applicable to the date of injury • Create, edit, and revise correspondence and case documentation • Utilize utilization review tools when indicated, including prospective, concurrent, and retrospective review, and physician advisor consultation • Educate injured workers and families on treatment plans, recovery expectations, and care coordination • Maintain strict confidentiality of all medical and case information in accordance with state and federal regulations • Serve as a patient advocate while adhering to all legal, ethical, and regulatory standards • Negotiate provider fees or refer cases to alternate vendors when appropriate and compliant with statutory requirements • May provide guidance or informal leadership to less-experienced staff • Perform other duties as assigned