Triage Telephonic Nurse Case Manager

Davies International Ltd. • Highland Home, AL

2d • $66,000 - $67,000 • 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 Triage Telephonic Nurse Case Manager, who is responsible for the initial medical management of Workers' Compensation claims at the outset of injury. This role independently conducts clinical assessments, completes the required three-point contact, and ensures injured workers receive appropriate, timely, and high-quality medical care in accordance with Florida state guidelines and emergency protocols. The position focuses on facilitating early intervention, reducing recovery time, and promoting a safe and prompt return-to-work.

Requirements

• Strong clinical assessment and critical-thinking skills.
• Working knowledge of Workers' Compensation medical management preferred.
• Understanding of current clinical trends, treatment standards, and regulatory changes.
• Ability to work independently while managing multiple priorities.
• Proficiency with computers and claims management systems.
• Excellent verbal and written communication skills.
• Strong customer service orientation and ability to work collaboratively in a team environment.
• Reliable attendance and professionalism.
• Active Registered Nurse (RN) license in good standing.
• Minimum of three (3) years of clinical nursing experience (medical-surgical, orthopedic, neurological, ICU/CCU, industrial, or occupational health).

Nice To Haves

• At least one (1) year of Workers' Compensation case management experience preferred.

Responsibilities

• Provide telephonic triage case management for Workers' Compensation claims at first notice of injury.
• Conduct comprehensive clinical assessments of injured workers to determine appropriate medical care and level of intervention.
• Complete initial assessment and three-point contact in compliance with State of Florida requirements.
• Develop and implement an initial case management care plan using information obtained from the injured worker, employer, and medical provider.
• Evaluate recovery needs and identify barriers to recovery, documenting findings for ongoing case planning.
• Identify and document causal relationship issues, notifying all appropriate parties within the system.
• Facilitate communication among injured workers, employers, claims professionals, insurers, healthcare providers, and vendor partners.
• Participate in a 24/7/365 intake call center environment, demonstrating knowledge of all departmental functions.
• Monitor treatment adherence to state-mandated guidelines, utilization criteria, and evidence-based protocols.
• Address return-to-work capabilities with injured workers and providers and document recommendations appropriately.
• Proactively manage files using established case management tools and best practices.
• Ensure accurate, timely, and thorough documentation of all contacts, assessments, and medical information in the computerized system.
• Maintain patient confidentiality in accordance with state and federal regulations, including HIPAA.
• Serve as a patient advocate while adhering to legal, ethical, accreditation, and regulatory standards.
• Assist with utilization tracking and medical services coordination to support quality outcomes and patient satisfaction.
• Create, edit, and revise system correspondence as needed.
• May negotiate provider fees, channel cases to vendors, or assist with training claims staff on identifying medical management opportunities.
• Participate in quality assurance initiatives and committees as assigned.
• Perform other duties as required to meet business needs.

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