Triage Telephonic Nurse Case Manager
About The Position
Davies North America is seeking an experienced Triage Telephonic Case Manager (RN) to join our Workers' Compensation managed care team. This role is responsible for providing clinical triage and telephonic case management services at the initial report of injury, ensuring injured employees receive appropriate, timely medical care while promoting recovery and return-to-work outcomes. The ideal candidate is a Registered Nurse with strong clinical assessment skills, workers' compensation knowledge, and the ability to make independent decisions in a dynamic, fast-paced environment. This position plays a critical role in the early intervention process, helping coordinate care, identify barriers to recovery, and advocate for injured workers while balancing client and regulatory requirements.
Requirements
- Current unrestricted Registered Nurse (RN) license.
- Minimum of 3 years of clinical nursing experience in one or more of the following: Medical-Surgical, Orthopedics, Neurology, Critical Care/ICU, Occupational Health, Industrial Nursing
- Strong clinical assessment and critical thinking skills.
- Excellent verbal and written communication skills.
- Ability to work independently and make sound clinical decisions.
- Proficiency with Microsoft Office Suite and healthcare or claims-related systems.
- Ability to manage multiple priorities in a fast-paced environment while maintaining attention to detail.
- Previous Workers' Compensation case management experience.
- Telephonic case management experience.
- Familiarity with state workers' compensation regulations and treatment guidelines.
- Clinical Assessment & Triage
- Workers' Compensation Case Management
- Return-to-Work Coordination
- Medical Documentation Review
- Care Coordination
- Customer Service Excellence
- Critical Thinking & Problem Solving
- Communication & Relationship Building
- Time Management & Organization
- Patient Advocacy
- Regulatory Compliance
- Independent Decision Making
Nice To Haves
- CCM (Certified Case Manager) designation or progress toward certification.
- Experience in utilization review or managed care environments.
- Experience working in a call center or high-volume intake environment.
- Bilingual skills are a plus.
Responsibilities
- Provide telephonic triage case management services at the onset of workers' compensation claims.
- Conduct comprehensive clinical assessments of injured employees at the time of injury and determine appropriate levels of care.
- Complete initial evaluations and required three-point contacts in accordance with state requirements and established protocols.
- Assess medical appropriateness of treatment and support timely access to care.
- Develop and implement initial case management care plans based on assessment findings.
- Coordinate communication among injured workers, employers, providers, claims professionals, and other stakeholders.
- Identify potential barriers to recovery and document findings for future case planning.
- Evaluate return-to-work capabilities and facilitate modified duty discussions when appropriate.
- Monitor treatment plans for compliance with state guidelines, evidence-based protocols, and client-specific requirements.
- Identify potential causation concerns and communicate findings to appropriate parties.
- Accurately document all assessments, contacts, medical information, and case activities within the claims management system.
- Serve as a patient advocate while maintaining compliance with all legal, ethical, and regulatory requirements.
- Support utilization management efforts through coordination of appropriate medical services and resources.
- Participate in quality assurance initiatives and departmental projects as assigned.
- Provide education and support to injured workers and their families throughout the recovery process.
- Assist in training claims personnel regarding medical case management opportunities and clinical considerations.
- Serve as a resource and mentor to team members as needed.
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
- Paid sick leave
- Paid family and parental leave
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
