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RN Medical Case Reviewer

State Of Wyoming

Job Location:

Cheyenne, WY - USA

Monthly Salary: Not provided by the employer

Posted: 6 June 2026 (30+ days ago)

Application Deadline: 3 September 2026

Vacancies: 1 Vacancy

The job posting is outdated and position may be filled

Job Summary

Description and Functions

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 nameCheyenne conjures up images of cowboys trains and the great outdoors. Todays Cheyenne is all of that and more! Well 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 worlds largest outdoor rodeo.
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!
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Human Resource Contact:

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 the claimants needs and medical records to direct medical case managementactivities.
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 Divisions 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.

Qualifications

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 interpretdiagnostic testing.
Abilityto critically analyze data.

MINIMUM QUALIFICATIONS:

Education:

Bachelors 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

Education & ExperienceSubstitution:

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

Necessary Special Requirements

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 including your rights and responsibilities.
For the Veterans 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.

Supplemental Information