HR Clinical Case Manager

Job Description

Job Description

Job Title: HR Clinical Case Manager

Job Description

The HR Clinical Case Manager supports a Disability Leave Service organization by providing expert clinical consultation on complex disability, leave, and accommodation cases. This role combines strong medical acumen with compassionate, business-focused case management to help employees successfully return to work while supporting organizational goals. You will review claims from a clinical perspective, partner closely with disability case managers, appeals consultants, and accommodation specialists, and translate medical information into clear, actionable recommendations.

Responsibilities

• Manage a caseload of approximately 50–60 cases per month, including 17–25 active short-term disability claims at any given time.
• Perform clinical claim reviews to evaluate medical documentation against established parameters and clinical criteria.
• Provide medical evaluations and clinical guidance to Disability Leave Service operations and the appeals unit.
• Serve as a clinical subject matter expert to disability case managers, offering analyses related to functional impairment, work capacity, and return-to-work readiness.
• Conduct peer clinical and appeal case consultations with treating providers to gain insight into medical restrictions and limitations, determine levels of functional capacity, and assist in developing return-to-work plans.
• Communicate directly with healthcare providers to gather additional information, clarify medical records, and assess whether functional impairments prevent employees from performing essential job functions.
• Determine whether disability claims are supported for specific durations based on medical documentation and clinical judgment.
• Escalate cases for clinical review when medical documentation exceeds standard guidelines and coordinate with clinicians by submitting cases into the clinical review queue.
• Utilize sound clinical judgment, critical thinking, and problem-solving skills to make timely, well-supported decisions.
• Collaborate with case managers, clinicians, operations, appeals, and vendor teams through established internal channels to ensure timely support, guidance, and case resolution.
• Provide continuing education and clinical guidance for case management staff to strengthen their understanding of medical issues impacting disability and accommodations.
• Assist in the creation of an integrated clinical management model in partnership with operations, appeals, and vendor teams.
• Support the development of clinical tools, templates, processes, and protocols under the direction of the clinical leadership team.
• Apply knowledge of medical diagnoses, ICD-10 codes, and functional impacts to evaluate how health conditions affect employees’ ability to perform essential job duties.
• Translate clinical expertise into practical consultations that support both employees and the organization in achieving successful return-to-work outcomes.
• Exercise strong self-management skills by organizing workload, prioritizing tasks, and maintaining attention to detail in a fast-paced environment.
• Re-engage with cases only when new tasks are generated, ensuring efficient workflow management.
• Provide guidance to operations teams on clinical aspects of disability, leave, and accommodations.
• Travel domestically and internationally up to 30% as needed to support clinical case management activities and stakeholder engagement.

Essential Skills

• Current Registered Nurse (RN) license or Bachelor of Science in Nursing (BSN) required.
• Minimum of 3 years of direct clinical work experience.
• Minimum of 3 years of clinical experience in any setting, with hands-on inpatient experience strongly beneficial.
• Strong medical acumen with the ability to understand and interpret medical diagnoses, ICD-10 codes, and their impact on functional capacity.
• Demonstrated clinical case management skills, including evaluating medical documentation and applying clinical criteria.
• Ability to exercise sound critical thinking and problem-solving skills with minimal guidance.
• Exceptional written and verbal communication skills, with the ability to confidently communicate with physicians and all levels of an employee’s treating provider team.
• Proven ability to work cross-functionally and collaborate with multiple stakeholder groups with varying levels of clinical knowledge.
• Strong organizational skills, attention to detail, and the ability to prioritize in a fast-paced environment.
• Ability to utilize clinical judgment in decision-making regarding disability claims and return-to-work recommendations.

Additional Skills & Qualifications

• 3+ years of experience in the disability management industry managing short-term disability (STD) or long-term disability (LTD) claims.
• Experience in disability management, case management, or workers’ compensation is a strong plus.
• Understanding of regulations under FMLA, ADAAA, EEOC, OFCCP, and various state and local leave of absence laws.
• Utilization review experience and/or experience using specific clinical criteria or protocols.
• Experience navigating large organizations and engaging multiple stakeholder groups.
• Experience with third-party administrators or similar environments is beneficial.
• Certification as a Certified Case Manager (CCM) or Certified Disability Management Specialist (CDMS) preferred.
• Strong interpersonal skills with a desire to share knowledge and support continuous learning within the team.
• Ability to balance compassionate employee support with business-focused case consultation.

Work Environment

This position operates in a 100% remote work environment, providing the opportunity to gain corporate-level experience within a niche disability and leave management team. Standard working hours are Monday through Friday, 8:00 AM to 5:00 PM, with flexibility of plus or minus one hour to accommodate personal scheduling needs. You will collaborate virtually with operations, appeals, vendor teams, and clinical stakeholders, using established internal channels and systems to manage cases and communicate with healthcare providers. The culture emphasizes professional communication, knowledge sharing, and a supportive, fast-paced environment focused on high-quality clinical decision-making and effective return-to-work outcomes

This is a Contract position based out of Springfield, IL.

The pay range for this position is $30.00 - $33.00/hr.

Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following:
• Medical, dental & vision
• Critical Illness, Accident, and Hospital
• 401(k) Retirement Plan – Pre-tax and Roth post-tax contributions available
• Life Insurance (Voluntary Life & AD&D for the employee and dependents)
• Short and long-term disability
• Health Spending Account (HSA)
• Transportation benefits
• Employee Assistance Program
• Time Off/Leave (PTO, Vacation or Sick Leave)

This is a fully remote position.

This position is anticipated to close on Jul 7, 2026.

Aston Carter provides world-class corporate talent solutions to thousands of clients across the globe. Specialized in accounting, finance, human resources, talent acquisition, procurement, supply chain and select administrative professions, we extend the capabilities of industry-leading companies. We draw on our deep recruiting expertise and expansive network to meet the evolving needs of our clients and talent community with agility and excellence. With offices across the U.S., Canada, Asia Pacific and Europe, Aston Carter serves many of the Fortune 500. We are proud to be a ClearlyRated Best of Staffing® Platinum Award winner for both client and talent service.

The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.

If you would like to request a reasonable accommodation, such as the modification or adjustment of the job application process or interviewing process due to a disability, please email View email address on ziprecruiter.com for other accommodation options.

San Francisco Fair Chance Ordinance: Pursuant to the San Francisco Fair Chance Ordinance, for all positions located in the city and county of San Francisco, we will consider for employment qualified applicants with arrest and conviction records.

Massachusetts Lie Detector: It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.

Use of Artificial Intelligence (AI): We may use Artificial Intelligence (AI) to support parts of our hiring process, including sourcing, screening, and evaluating candidates. AI helps assess applications and qualifications, but final decisions are made by our hiring team. By applying, you acknowledge and agree that your application may be reviewed using AI tools.