Telephonic Nurse Case Manager; Remote

Telephonic Nurse Case Manager (Remote)

Department: Claims Administration & Adjusting

Employment Type: Permanent - Full Time

Location: Home United States

Reporting To: Karen Shaffer

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're on the lookout for a Telephonic Nurse Case Manager to join our growing team! As a Telephonic Nurse Case Manager, you will be responsible for monitoring, evaluating and coordinating the delivery of high quality, timely, cost-effective medical treatment and other health services under Workers’ Compensation law. Reporting to the Case Management Supervisor, you will also perform ongoing assessments of the injured employee’s recovery to ensure high quality of care, reduce recovery time and minimize the effects of injury.

This role is a full-time, home-based position.

• Providing telephonic case management in a Workers’ Compensation environment while focusing on medical appropriateness of care to injured worker with cost savings by coordination and utilization of all services, ensuring that as soon as medically feasible, return-to-work status is achieved, along with increase in productivity
• Facilitating communication between the employee, the employee representative, employer, employer representative, insurer, health care provider, the medical services organization and when authorized, any qualified rehabilitation consultant, to achieve the goals
• Ensuring appropriate, progressive education is provided to the injured employee in a consistent manner while documenting in the system
• Identifying barriers to recovery and formulating a plan to overcome the barriers
• Clinically evaluating the recovery needs of an injured employee after the initial contact assessment and providing ongoing assessment of health and medical records
• Evaluating treatment plans while tracking and modifying appropriately, and documenting outcomes; developing alternative treatment plans as necessary
• Tracking protocol management for appropriate utilization and delivery of medical services
• Serving as a patient advocate adhering to all legal, ethical and accreditation/regulatory standards
• Exhibit company values of We are Dynamic, We are Innovative, We are Connected, and We Succeed Together
• Perform other duties as assigned

• RN with 3-5 years clinical experience (medical-surgical, orthopedic, neurological, ICCU, industrial or occupational)
• Must possess one of the following certifications: CCRN, CCM, CDMS, COHN, COHN‑S if managing a WC/MCO claim
• At least 1 years’ experience handling Workers’ Compensation case management
• Proof of current State Licensure and eligible for endorsement in all other states
• Bi-lingual – fluent English/Spanish helpful
• Case-management experience mandatory – at least 1 year Workers’ Compensation
• Field case or catastrophic case management and utilization review experience is highly preferred
• Ability to demonstrate strong focus on cost containment to manage cases in most cost-effective way while still ensuring quality medical care
• Maintain knowledge of current trends, standards and law changes appropriate to the law at the date of injury
• Must be self-directed and able to work independently
• Ability to effectively operate a personal computer and related claims and business software.
• Good communication skills, both oral and written
• Must be a team player with superb customer…