RN, Nurse Case Manager/UR Nurse

Intercare Holdings Insurance Services

. Triage all assigned claims within 24 hours of assignment .

Posted 10/2/2026full-timeAustin • Texas • United StatesJunior💰 $78,000 - $87,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in Utilization Review and Disability Management within California Workers’ Compensation, ensuring compliance with state regulations and effective communication with all stakeholders. Proficient in evaluating medical appropriateness and coordinating care while maintaining strong organizational and time management skills.

Highest-signal resume keywords

Active RN License In CaliforniaUtilization Review ExperienceCalifornia Workers’ Compensation FamiliarityManaged Care ExperienceClinical Experience

ATS Keywords

Tailor your resume

Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills

Utilization ReviewDisability ManagementMedical Diagnosis EvaluationTreatment Protocol ReviewPre-Authorization ProceduresEvidence-Based Guidelines ApplicationCost-Effective Medical Care CoordinationMTUS GuidelinesACOEM GuidelinesMCG Guidelines

Soft Skills

Strong Organizational SkillsAttention To DetailTime Management SkillsAbility To MultitaskEffective Communication

Certifications & Qualifications

Active RN License

Industry Keywords

California Labor CodeCalifornia Code Of RegulationsPeer Clinical ReviewPPO/MPN Network UtilizationQuality Management

About the role

Key responsibilities & impact

Triage all assigned claims within 24 hours of assignment
Complete initial contacts with the employee, employer, and Primary Care Physician and document referrals within 72 hours when applicable
Initiate disability management when needed to identify anticipated lost time and coordinate return-to-work processes
Address medical issues for assigned claims and coordinate timely, appropriate, cost-effective medical care
Review treatment referrals for medical appropriateness using evidence-based guidelines, best practices, and state-specific rules
Identify medical diagnoses and treatment plans and validate corresponding care algorithms
Review treatment protocols and make recommendations using MTUS, ACOEM, MCG, ODG, state-specific treatment guidelines, and provider documentation
Evaluate over-utilization and negotiate with providers to amend or withdraw treatment requests when appropriate
Refer potential non-certified cases to peer clinical reviewers
Perform utilization review on concurrent requests and arrange peer-to-peer contact as needed
Assist with notification of physician-reviewer non-certifications
Direct and maximize PPO/MPN network utilization
Pre-authorize appropriate inpatient and outpatient procedures
Communicate utilization-review determinations to claims examiners, providers, attorneys, and auxiliary providers within prescribed time frames, followed in writing within 24 hours
Summarize medical records and pertinent information for Physician Advisors and prepare questions for peer or third-party review
Work closely with clients, claims handlers, nurse case managers, and supervisors, taking direction when needed
Direct non-clinical tasks to non-clinical staff when required
Perform California utilization review in compliance with the Labor Code and California Code of Regulations
Follow applicable state rules and regulations for utilization review
Participate in quality-management meetings and projects for at least 5% of average hours worked
Oversee non-clinician tasks and support non-clinical administrative staff during initial screening
Monitor potential compromises to patient safety and refer them to the proper authority
Communicate in plain language with injured workers, claims examiners, and clients

Requirements

What you’ll need

Active RN license in California, with a scope of practice relevant to the clinical area(s) addressed in the initial clinical review
Minimum of 1 year clinical experience
Familiarity with California Workers’ Compensation
Managed Care experience/Utilization Review experience recommended
Completion of IEA CA 10 class within 1 year of employment if no prior workers’ compensation experience
Ability to multitask and adapt to changing work priorities
Strong organizational skills and attention to detail
Strong time management skills
Ability to work well with co-workers, clients, vendors, and others
Ability to follow directions
Must be able to perform each essential duty satisfactorily

Benefits

Comp & perks

Comprehensive medical, dental, and vision benefits
Company contributions to HSA and FSA plans
Employer paid life and disability insurance
401(k) with company match
Paid time off (PTO) and company paid holidays
Learning and development opportunities that support real career advancement
Employee assistance resources
Supportive culture that values balance and wellbeing