RN-Medical Case Reviewer 2026-01345

GENERAL DESCRIPTION

The Wyoming Department of Workforce Services is seeking a Nurse Case Manager to coordinate, evaluate, and monitor medical care services provided to injured workers receiving benefits under the Workers' Compensation system. This position works closely with healthcare providers, employers, and division professionals to coordinate treatment plans and support injured workers in returning to their pre-injury level of functioning and employment. Responsibilities include evaluating claimant needs and medical records to direct medical case management activities and ensuring that appropriate medical care is delivered in compliance with division statutes, rules, regulations, and treatment guidelines. The position performs medical review screenings on pre-authorization requests for surgical procedures, obtains and reviews supporting medical documentation, and refers cases for peer review when indicated. Additional duties include documenting all interactions, reviews, approvals, and denials within the claims management system; reviewing CPT and ICD-10 codes and surgical descriptions for accuracy; and maintaining tracking systems for pre-authorizations, surgical procedures, clinical bills, and prescription requests. The Nurse Case Manager also reviews provider requests for compliance with treatment guidelines and serves as a medical resource for claims analysts by preparing medical questions for various evaluations. This position further reviews medical bills, prescription requests, urinalysis drug screens (UDS), chiropractic and physical therapy treatments, and durable medical equipment (DME) requests to determine medical relatedness and appropriateness of care. Laramie County is located in the southeast corner of Wyoming. Around the world, the very name Cheyenne conjures up images of cowboys, trains, and the great outdoors. Today's Cheyenne is all of that and more! We'll always be here, ready to outfit you in new boots and hats, to point out the Wild-West history in our unique downtown, and to set you front and center at the world's largest outdoor rodeo.

https:

//www.cheyenne.org/?gclid=CjwKCAiAxvGfBhB-EiwAMPakqkdM1f50qh80FIuSwquGFSQioA8AqAXtvN3p2rEJexWgdaTHsNV4GRoCAHIQAvD_BwE Working for the State of Wyoming offers more than a paycheck.

Our total compensation package includes:

Comprehensive health, dental, and vision insurance Paid vacation, sick leave, FMLA, and holidays Retirement - Pension and 457B plans that help you build a secure future Flexible schedules and work-life balance options Meaningful work that makes a difference for Wyoming communities and

MUCH MORE!

Click here for detailed information , or you can watch this short video to learn about our benefit package! Want to see the full value of your compensation beyond salary? Explore our

Total Compensation Calculator:

https://compensationcalculator.wyo.gov

Human Resource Contact:

307-473-3270 ESSENTIAL

FUNCTIONS

The listed functions are illustrative only and are not intended to describe every function that may be performed at the job level. Evaluate claimant needs and medical records to direct medical case management activities. Provide assistance to healthcare providers, employers, and division professionals in coordinating care and treatment plans. Ensure that appropriate medical care is delivered to injured workers in a manner that is consistent with the statutes, rules, and regulations of the division. Perform a medical review screening on pre-authorization requests for proposed surgical procedures. Obtain all medical documentation to accompany the pre-authorization requests. Refer cases for peer review as indicated by treatment guidelines and medical reviews. Document all interactions, reviews, approvals, and denials in the claims management system. Review CPT and ICD-10 codes and surgical descriptions for accuracy on pre-authorization requests. Review medical documentation utilizing the Division's treatment guidelines for surgical procedures. Maintain tracking of all pre-authorization referrals, surgical procedures, clinical bills, and prescription requests Review pre-authorization provider requests for compliance with treatment guidelines. Act as a medical resource for claims analysts; write medical questions for multiple types of evaluations. Review medical bills, prescription requests, UDS, chiro/PT treatments, and DME for relatedness.

KNOWLEDGE

Knowledge of community resources. Skills in counseling and consultation. Ability to apply principles of nursing, particularly medical terminology, and physical and psychosocial principles. Ability to interpret diagnostic testing. Ability to critically analyze data.

MINIMUM QUALIFICATIONS

Education:

Bachelor's Degree (typically in Nursing)

Experience:

1-2 years of progressive work experience (typically in Nursing)

Certificates, Licenses, Registrations:

Must be licensed or eligible for licensure as a Registered Nurse (RN) in the

State of Wyoming OR Education & Experience Substitution:

4-6 years of progressive work experience (typically in Nursing)

Certificates, Licenses, Registrations:

Must be licensed or eligible for licensure as a Registered Nurse (RN) in the State of Wyoming

PHYSICAL WORKING CONDITIONS

Minimal travel may be required.

NOTES:

FLSA:

Exempt The Wyoming Department of Workforce Services (DWS) uses E-Verify, an Internet-based system, to confirm the eligibility of all newly hired employees to work in the United States.

Learn more about https:

//www.e-verify.gov/ , including your rights and responsibilities. For the Veteran's preference consideration, supporting documentation must accompany your application. Former State of Wyoming employees, who are rehired within 31 days from their previous employment, will be required to reimburse the State of Wyoming for all Vacation and Sick leave compensation received upon separation. Offers of employment will be contingent upon the successful completion of a background check. 053-Department of Workforce Services - Administration - Workers' Safety & Compensation Click here to view the State of Wyoming Classification and Pay Structure. Click here to view the State of Wyoming Total Compensation Calculator.

URL:

http://agency.governmentjobs.com/wyoming/default.cfm The State of Wyoming is an Equal Opportunity Employer and actively supports the ADA and reasonably accommodates qualified applicants with disabilities. Class Specifications are subject to change; please refer to the

A & I HRD

Website to ensure that you have the most recent version.