RN Telephonic Nurse Case Manager
About The Position
Imagine being part of a team that’s not just shaping the future but actively driving it. At Davies North America, we’re at the forefront of innovation and excellence, blending cutting-edge technology with top-tier professional services. As a vital part of the global Davies Group, we help businesses navigate risk, optimize operations, and spearhead transformation in the insurance and regulated sectors. We are looking for a Telephonic Nurse Case Manager (RN), who independently manages medical aspects of Workers’ Compensation claims, ensuring the delivery of high-quality, timely, and cost-effective care to injured employees. This role monitors, analyzes, evaluates, and coordinates medical treatment throughout the continuum of care to promote medically appropriate, prompt return-to-work outcomes. The Telephonic Case Manager proactively identifies barriers to recovery, develops action plans, and serves as both patient advocate and clinical resource while maintaining compliance with regulatory and client-specific guidelines.
Requirements
- Active, unrestricted RN license.
- Minimum 3 years of clinical experience (medical-surgical, orthopedic, neurological, ICCU, industrial, ER, or occupational health).
- Strong knowledge of treatment guidelines and utilization management principles.
- Excellent verbal and written communication skills.
- Ability to work independently in a remote environment.
- Proficiency in computer systems and claims/case management software.
- Telephonic case management experience.
- Experience applying evidence-based disability duration guidelines.
- Prior experience training or mentoring staff.
Nice To Haves
- Workers’ Compensation case management experience preferred.
Responsibilities
- Provide telephonic case management for Workers’ Compensation cases.
- Assess medical appropriateness of treatment plans and coordinate services to optimize recovery and cost efficiency.
- Develop, implement, and modify individualized case management care plans.
- Perform ongoing clinical assessments and review medical records to ensure quality and timely care.
- Identify and address barriers to recovery with proactive action planning.
- Coordinate communication between injured workers, employers, providers, insurers, and other stakeholders.
- Promote and document return-to-work capability at each medical milestone.
- Ensure compliance with state-mandated treatment guidelines, nationally published protocols, and client requirements.
- Track outcomes including patient satisfaction, return-to-work progress, and disability duration.
- Utilize utilization review tools when indicated (pre-certification, concurrent review, retrospective review, medical director review).
- Monitor provider and vendor performance to ensure quality and appropriate care delivery.
- Maintain detailed and accurate documentation within the case management system.
- Serve as a patient advocate while adhering to all legal, ethical, accreditation, and regulatory standards.
- Participate in Quality Assurance, Grievance, or other committees as assigned.
- Provide training or mentorship to claims staff or junior team members as appropriate.
- Perform additional duties as assigned.
Benefits
- Medical, dental, and vision plans to support your health and that of your family
- A 401(k) plan with employer matching
- Time‑off policies, including Discretionary Time Off (DTO) for exempt employees and Paid Time Off (PTO) for non‑exempt employees
- Paid holidays
- Life insurance and short‑term and long‑term disability coverage
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
Number of Employees
101-250 employees
