RN Telephonic Nurse Case Manager

Davies • Home, WV

5h • $80,000 - $85,000 • Remote

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.

Nice To Haves

• Workers’ Compensation case management experience preferred.
• Prior experience training or mentoring staff.

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 ensure your health and that of your family.
• A 401k plan with employer matching to help you build a secure financial future.
• Our time-off policies, including Discretionary Time Off for exempt employees and Paid Time Off (PTO) package for non-exempt employees, reflect our commitment to promoting a healthy work environment.
• Paid holidays.
• Life insurance and both short-term and long-term disability plans, providing essential financial protection for you and your loved ones.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed