• Provide telephonic case management for Workers’ Compensation cases. • Assess medical appropriateness of treatment plans and coordinate services to optimize recovery and cost efficiency. • Develop, implement, and modify individualized case management care plans. • Perform ongoing clinical assessments and review medical records to ensure quality and timely care. • Identify and address barriers to recovery with proactive action planning. • Coordinate communication between injured workers, employers, providers, insurers, and other stakeholders. • Promote and document return-to-work capability at each medical milestone. • Ensure compliance with state-mandated treatment guidelines, nationally published protocols, and client requirements. • Track outcomes including patient satisfaction, return-to-work progress, and disability duration. • Utilize utilization review tools when indicated (pre-certification, concurrent review, retrospective review, medical director review). • Monitor provider and vendor performance to ensure quality and appropriate care delivery. • Maintain detailed and accurate documentation within the case management system. • Serve as a patient advocate while adhering to all legal, ethical, accreditation, and regulatory standards. • Participate in Quality Assurance, Grievance, or other committees as assigned. • Provide training or mentorship to claims staff or junior team members as appropriate. • Perform additional duties as assigned.