Job Title: Workers' Compensation Case Review Nurse (PH Registered Nurse)

Location: Onsite – Bonifacio Global City (BGC)

Shift: US Operational Hours

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About the Role

We are looking for a Philippines-registered nurse (RN) to join our growing Workers’ Compensation team. This role requires a clinical professional who will be responsible for reviewing complex workers’ compensation claims involving serious injuries and prolonged treatments. The nurse will coordinate return-to-work (RTW) plans, collaborate with multiple stakeholders (injured worker, employer, physician, attorney), and provide clinical expertise to ensure medically necessary and cost-effective care delivery.

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Key Roles & Responsibilities

Review workers’ compensation claims involving serious injuries or lengthy treatments.

Create and monitor return-to-work (RTW) plans tailored to each case.

Act as the single point of contact for injured employees throughout the claim lifecycle.

Coordinate with medical providers, employers, and attorneys to track progress and resolve barriers to care.

Assess medical reports and case files to ensure care is necessary and aligned with clinical guidelines.

Document all case management activities in the case management system accurately and thoroughly.

Communicate consistently with claims adjusters and clients to ensure medical and RTW goals are met.

Identify the need for job modifications and collaborate with employers based on employee capabilities.

Use clinical judgment to suggest alternative treatments or escalate cases to physician advisors when needed.

Evaluate ongoing treatment and update plans according to recovery progress and protocols.

Engage specialty resources (behavioral health, peer reviews, medical director) as required.

Stay current with market trends, medical treatment advances, and workers’ compensation guidelines.

Perform other duties as assigned.

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Required Qualifications

Bachelor’s degree in Nursing (BSN)

Active, unrestricted RN license (PRC-verified)

1–2 years of relevant clinical experience in:

Medical/Surgical Units

Orthopedics

ICU/CCU

Emergency Room

Rehabilitation

Written and verbal fluency in English

Willingness to work onsite (BGC)

Willingness to work US business hours

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Preferred Qualifications

Proficiency in Microsoft Office Suite: Word, Excel, PowerPoint, Visio, Project, SharePoint

Knowledge of:

Workers’ compensation regulations and practices

Case management and URAC standards

Pain management, pharmaceuticals, and rehabilitation

ODG guidelines, periods of disability, and return-to-work protocols

Strong analytical, leadership, and organizational skills

Motivational and collaborative team player

Ability to consistently meet or exceed performance metrics