Cardiac Telephonic Nurse Case Manager

Cardiac Telephonic Nurse Case Manager

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 seeking an experienced Cardiac Telephonic Nurse Case Manager to manage Workers' Compensation medical cases involving cardiac conditions and related treatment plans.

In addition to traditional telephonic case management responsibilities, this role requires a strong clinical background in cardiac care and the ability to evaluate complex cardiovascular diagnoses, treatment plans, procedures, medications, and recovery progress. The ideal candidate will leverage their clinical expertise to coordinate care, identify barriers to recovery, facilitate appropriate return-to-work outcomes, and ensure injured workers receive high-quality, evidence-based treatment throughout the continuum of care.

• Utilize advanced cardiac clinical knowledge to review, evaluate, and coordinate treatment plans involving cardiovascular conditions, cardiac procedures, and related medical care.
• Monitor recovery progress and treatment outcomes for injured workers with cardiac injuries, diagnoses, or comorbidities.
• Collaborate with treating physicians, cardiologists, healthcare providers, employers, adjusters, and injured workers to support optimal medical and return-to-work outcomes.
• Evaluate medical necessity and appropriateness of cardiac treatment plans utilizing evidence-based treatment guidelines and clinical best practices.
• Identify barriers to recovery specific to cardiac conditions and develop appropriate intervention strategies.
• Educate injured workers regarding cardiac diagnoses, treatment recommendations, medication compliance, lifestyle modifications, and recovery expectations as appropriate.
• Review medical records, treatment plans, diagnostic testing, and provider recommendations.
• Encourage injured worker participation in treatment and recovery plans.
• Evaluate return-to-work capabilities and discuss restrictions with providers and employers.
• Obtain and review job descriptions to assist providers in determining appropriate work capacity.
• Coordinate modified duty and transitional return-to-work opportunities when medically appropriate.
• Adhere to state treatment guidelines, evidence-based protocols, account requirements, and organizational standards.
• Monitor compliance with ODG, ACOEM, state-specific treatment guidelines, and utilization criteria as applicable.
• Identify cases requiring utilization review, physician review, pre-certification, pre-authorization, concurrent review, or retrospective review.
• Track treatment outcomes, disability durations, and return-to-work progress.
• Maintain timely, accurate, and thorough case documentation within electronic case management systems.
• Ensure compliance with HIPAA and all applicable state and federal privacy regulations.
• Serve as a patient advocate while maintaining legal, ethical, and regulatory standards.
• Participate in quality improvement initiatives, client meetings, and team collaboration activities as needed.
• Assist with training, mentoring, and knowledge-sharing opportunities when appropriate.
• Perform additional duties and special projects as assigned.

• Active Registered Nurse (RN) license with proof of current state licensure.
• Minimum of 3 years of clinical nursing experience.
• Minimum of 3 years of Workers' Compensation case management experience preferred.
• Recent cardiac clinical experience is required.
• Cardiac experience may include one or more of the following:
• Working on a Cardiac Unit or Cardiac Step-Down Unit.
• Critical Care/ICU experience managing cardiac patients.
• Experience titrating cardiac drips and monitoring complex cardiac conditions.
• Employment within a Cardiology Practice or Cardiology Provider Office.
• Interventional Radiology experience supporting cardiac procedures.
• Cardiac Catheterization…