Telephonic Nurse Case Manager: FL RN License (Remote)

Davies • Home, WV

23h • $78,000 - $82,000 • Remote

About The Position

Davies North America is seeking an experienced Telephonic Nurse Case Manager to manage medical claims and make independent decisions about care. The role monitors, analyzes, evaluates, and coordinates high-quality, timely, cost-effective medical treatment and other health services for injured employees. The goal is to support an appropriate and prompt return to work when medically indicated, manage care across the continuum of services, and assess recovery to promote quality care, reduce recovery time, and minimize the effects of injury. The position performs telephonic case management for Workers’ Compensation cases according to identified parameters and requires a Florida RN license.

This is a full-time, permanent remote position. The listed annual compensation range is $78,000–$82,000. Candidates need at least three years of clinical experience as an RN and at least three years of Workers’ Compensation experience. Case-management experience is desired, with Workers’ Compensation experience preferred.

Requirements

• Current Florida RN license is required; proof of current state licensure is required.
• At least three years of RN clinical experience in medical-surgical, orthopedic, neurological, ICCU, industrial, emergency room, or occupational settings.
• At least three years of Workers’ Compensation experience.
• Ability to work independently and be self-directed.
• Ability to operate a personal computer and related claims and business software effectively.
• Good oral and written communication skills, teamwork, attendance, and customer service skills.
• Maintain knowledge of current trends, standards, and changes in law.

Nice To Haves

• Compact RN license preferred.
• Case-management experience desired, with Workers’ Compensation case-management experience preferred.

Responsibilities

• Provide telephonic case management in a Workers’ Compensation environment, coordinating services to support medically appropriate care, cost savings, and return to work as soon as medically feasible.
• Facilitate communication among the injured employee, representatives, employer, insurer, health care providers, managed care organization, and authorized rehabilitation consultants.
• Build and maintain strong client relationships, meet or exceed client expectations, and follow policies and procedures.
• Assess an injured employee’s recovery needs after initial contact and incorporate information from the employer and provider into the initial plan.
• Provide and document progressive education for injured employees.
• Identify barriers to recovery and formulate action plans to address them.
• Conduct ongoing assessments of health and medical records.
• Monitor and audit provider and vendor performance and care.
• Develop, track, and appropriately modify case-management care plans.
• 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, document the discussion, and obtain and present the employer’s job description to the provider when necessary.
• Manage files in accordance with state-mandated treatment guidelines, utilization criteria, published protocols, and account requirements.
• Evaluate treatment plans, document outcomes, and track protocol management and utilization of medical services against clinical guidelines and outcome criteria.
• Proactively manage cases using appropriate case-management tools and develop alternative treatment plans when needed.
• Identify the need for utilization review procedures, communicate findings, and document them appropriately.
• Anticipate health needs, educate patients and families, and encourage injured workers to participate in 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 appropriate 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 and dependable attendance and be available to perform 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.
• Paid sick leave, paid family and parental leave, and other mandated benefits where required by law.

What This Job Offers

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