Telephonic Nurse Case Manager: California RN License; Remote

Department: Claims Administration & Adjusting

Employment Type: Permanent - Full Time

Location: Home United States

Reporting To: Nurse Case Manager Supervisor

Compensation: $83,000 - $88,000 / year

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.

Davies Claims North America is seeking an experienced Telephonic Nurse Case Manager to join our team. You will be responsible for the management and independent decision making on medical claims. You will analyze, evaluate and coordinate the delivery of high quality, timely, cost effective medical treatment and other health services as needed by an injured employee to promote an appropriate, prompt return to work when medically indicated.

Manages all care throughout the continuum of services in order to achieve the highest level of quality medical care in the most cost effective and timely manner possible. You will perform ongoing assessments of the injured employee’s recovery to ensure high quality of care, reduce recovery time and minimize the effects of injury. Performs Telephonic Case Management activity on Workers’ Compensation cases according to parameters identified.

Must have California RN, or ability to obtain California endorsement within 6 months.

• Provide telephonic case-management in a Workers’ Compensation environment. Focus 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.
• Facilitate communication between the employee, the employee representative, employer, employer representative, insurer, health care provider, the managed care organization and when authorized, any qualified rehabilitation consultant, to achieve the goals ensuring excellent customer relationships and quality customer service.
• Build and maintain excellent rapport with client contacts to ensure retention; perform in manner to meet/exceed client expectations, following policy and procedure.
• Clinically evaluate the recovery needs of an injured employee after the initial contact assessment. Incorporate into the initial plan information obtained from the employer and provider.
• Ensure appropriate, progressive education is provided to the injured employee in a consistent manner, and documented in the system.
• Identify barriers to recovery and formulates an action plan to overcome these barriers.
• Provide ongoing assessment of health and medical records.
• Monitor and audit provider and vendor performance and care.
• Develop case management care plan, track and modify appropriately.
• Appropriately document all data received from interviews, contacts and medical records in the computerized system.
• Address the return-to-work capability with the injured worker and provider at each medical evaluation. Document appropriately in computerized system. Obtain a job description from the employer and presents to the provider if necessary.
• Manage the file adhering to treatment guidelines and utilization criteria as determined by the state‑mandated guidelines, proprietary and nationally published protocols, as well as account requirements, assuring smooth delivery of services to injured workers or third party claimants.
• Evaluate treatment plans and documents…