Telephonic Nurse Case Manager: FL RN License (Remote)

Davies • Home, AL

11d • Remote

About The Position

Davies North America is seeking an experienced Telephonic Nurse Case Manager to manage medical claims and make independent decisions in a Workers’ Compensation environment. The role monitors, analyzes, evaluates, and coordinates high-quality, timely, cost-effective medical treatment and other health services for injured employees, supporting an appropriate return to work when medically indicated. The nurse manages care across the continuum of services and assesses recovery to promote quality care, reduce recovery time, and minimize the effects of injury.

The position conducts telephonic case management, coordinates care and communication among injured employees, employers, insurers, providers, and other authorized parties, and develops and monitors individualized case-management plans. The role applies treatment guidelines and utilization criteria, identifies barriers to recovery, evaluates treatment plans and outcomes, and documents case activity in computerized systems. The successful candidate must hold a Florida RN license and be able to work independently while delivering quality customer service.

Requirements

• Florida RN license is required.
• Registered Nurse with at least three years of clinical experience in medical-surgical, orthopedic, neurological, ICCU, industrial, ER, or occupational settings.
• At least three years of Workers’ Compensation experience.
• Current state licensure.
• Ability to work independently and be self-directed.
• Ability to operate a personal computer and related claims and business software.
• Good oral and written communication skills.
• Team-oriented approach.
• Good attendance and customer service skills.

Nice To Haves

• Compact nursing license preferred.
• Case-management experience desired, with Workers’ Compensation experience preferred.
• Knowledge of current trends, standards, and changes in applicable laws.

Responsibilities

• Provide telephonic case management for Workers’ Compensation cases.
• Coordinate services and care to support medically appropriate treatment, cost savings, and return to work as soon as medically feasible.
• Facilitate communication among the employee, representatives, employer, insurer, health care provider, managed care organization, and other authorized parties.
• Maintain client relationships and meet or exceed client expectations while following policies and procedures.
• Clinically evaluate an injured employee’s recovery needs and incorporate information from the employer and provider into the initial plan.
• Provide and document consistent education for injured employees.
• Identify barriers to recovery and formulate action plans to address them.
• Assess health status and medical records on an ongoing basis.
• Monitor and audit provider and vendor performance and care.
• Develop, track, and modify case-management care plans as appropriate.
• Document information from interviews, contacts, and medical records in the computerized system.
• Discuss return-to-work capability with the injured worker and provider at each medical evaluation and document the discussion.
• Obtain job descriptions from employers and present them to providers when necessary.
• Manage cases according to state-mandated guidelines, proprietary and nationally published protocols, and account requirements.
• Evaluate treatment plans, document outcomes, and track protocol management and appropriate utilization of medical services.
• Monitor patient satisfaction, quality and appropriateness of care, timely recovery, return-to-work outcomes, and length of disability using applicable evidence-based criteria and clinical guidelines.
• Manage files proactively using appropriate case-management tools and develop alternative treatment plans when necessary.
• Adapt case-management processes to support more refined and efficient service delivery.
• Identify cases requiring utilization review, including potential barriers to recovery; use applicable review tools and communicate and document findings.
• Anticipate health needs and educate patients and families appropriately.
• Encourage injured workers to participate in their recovery plans.
• Protect the confidentiality of medical records and case- and provider-specific information in accordance with applicable laws and regulations.
• Advocate for patients while adhering to legal, ethical, accreditation, and regulatory standards.
• Serve on committees such as Grievance and Quality Assurance committees as directed.
• Negotiate provider fees or direct cases to other vendors when appropriate.
• Train claims staff to identify medical case-management opportunities when needed.
• Provide leadership to lower-graded department staff when needed.
• Perform other duties as needed.
• Maintain regular, dependable attendance and be available to perform job responsibilities during established work hours.

Benefits

• Medical, dental, and vision plans.
• 401(k) plan with employer matching.
• Discretionary Time Off for exempt employees and Paid Time Off for non-exempt employees.
• Paid holidays.
• Life insurance.
• Short-term and long-term disability coverage.
• Where required by law, paid sick leave, paid family and parental leave, and other mandated benefits.

What This Job Offers

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