Cardiac Nurse Case Manager

Department: Claims Administration & Adjusting Location: Orlando, FL Compensation: $78,000 - $85,000 / year Description Our Story 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 North America is growing! We are currently looking to fill our Cardiac Nurse Care Manager role. The perfect candidate will be responsible for the clinical management and independent decision‑making associated with complex cardiac‑related workers' compensation claims involving Florida first responders, including law enforcement officers, firefighters, correctional officers, EMTs, paramedics, and other eligible employees covered under Florida's Heart/Lung Bill and related presumptive legislation. You will provide telephonic case management services and clinical oversight throughout the continuum of care for cardiac and cardiovascular‑related claims. Monitors, analyzes, evaluates, and coordinates high‑quality, evidence‑based medical treatment and ancillary services to ensure appropriate medical management, timely recovery, and cost‑effective outcomes. Performs ongoing assessments of the injured worker's medical status, treatment progression, functional capacity, and return‑to‑work potential when medically appropriate. Also serve as a key client‑facing clinical resource, partnering closely with claims professionals, employers, attorneys, medical providers, and client stakeholders. Participates in weekly client claims review meetings, providing clinical updates, identifying barriers to claim resolution, discussing treatment plans and outcomes, and making recommendations to support effective claim management and client satisfaction. Key Responsibilities Provide telephonic nurse case management services for complex cardiac and cardiovascular workers' compensation claims involving Florida first responders. Assess, coordinate, and monitor medical treatment related to cardiac diagnoses, including but not limited to myocardial infarction, coronary artery disease, hypertension‑related cardiac conditions, arrhythmias, cardiomyopathy, heart failure, and other cardiovascular disorders. Facilitate communication among injured workers, employers, adjusters, attorneys, medical providers, rehabilitation professionals, and client representatives to ensure coordinated and efficient claim resolution. Serve as a clinical liaison for client accounts, building and maintaining strong professional relationships through proactive communication and exceptional customer service. Participate in weekly client claims review meetings to discuss claim status, treatment progression, barriers to recovery, cost drivers, litigation concerns, return‑to‑work opportunities, and recommendations for future claim handling. Prepare and present clinical summaries, action plans, and recommendations for client review meetings. Evaluate the medical necessity, appropriateness, and effectiveness of treatment plans using evidence‑based medicine, Florida Workers' Compensation guidelines, and relevant cardiac care standards. Conduct comprehensive clinical assessments and develop individualized case management plans based on medical records, provider communications, and injured worker interviews. Identify barriers to medical recovery, claim resolution, and return‑to‑work outcomes, and develop strategies to address those barriers. Monitor treatment adherence, provider performance, and clinical outcomes to promote quality care and cost containment. Review cardiac diagnostic testing, specialist consultations, medications, procedures, hospitalizations, rehabilitation services, and treatment recommendations. Collaborate with treating physicians and specialists to ensure treatment plans support optimal recovery and functional improvement. Provide ongoing education to injured workers regarding their cardiac condition, treatment plan, lifestyle modifications, medications, and recovery expectations. Ensure all clinical documentation is accurate, timely, and compliant with state regulations, client requirements, and company standards. Maintain comprehensive case notes, treatment summaries, and action plans within the claims management system. Proactively manage claims using appropriate case management tools and resources to achieve favorable medical and financial outcomes. Identify situations requiring utilization review, peer review, medical director consultation, independent medical examinations, or additional clinical interventions. Monitor claim progression and recommend appropriate referrals for vocational rehabilitation, functional capacity evaluations, specialty services, or alternative treatment options when indicated. Evaluate return‑to‑work capabilities and restrictions in collaboration with treating physicians and employers when medically appropriate. Advocate for quality patient care while balancing regulatory compliance, client expectations, and cost‑effective claim management. Participate in quality assurance initiatives, client service activities, and departmental improvement efforts. May assist in training claims professionals and clinical staff regarding cardiac claims management, Florida presumptive legislation, and complex medical issues. May provide mentorship and clinical guidance to less experienced case management staff. Perform other duties as assigned. Skills, knowledge & expertise Competencies - Knowledge, Abilities and Skills: Extensive knowledge of cardiac and cardiovascular conditions, treatment protocols, and recovery expectations. Strong understanding of Florida Workers' Compensation regulations, including presumptive claims applicable to first responders. Knowledge of Florida Heart/Lung Bill provisions and their impact on claim management preferred. Ability to analyze complex medical records and formulate effective clinical recommendations. Demonstrated ability to build trusted relationships with clients, adjusters, attorneys, providers, and injured workers. Strong presentation and communication skills with the ability to effectively discuss claims during client review meetings. Excellent critical thinking, clinical assessment, and problem‑solving abilities. Strong organizational and time management skills. Ability to work independently while managing multiple complex claims. Proficiency with claims management systems, electronic medical records, and Microsoft Office applications. Excellent written and verbal communication skills. Commitment to exceptional customer service and client satisfaction. Minimum Qualifications Current Registered Nurse (RN) license in good standing; compact license preferred. Minimum of three (3) years of clinical nursing experience in one or more of the following areas: Cardiology Critical Care/ICU Coronary Care Unit (CCU) Emergency Department Occupational Health Medical‑Surgical Nursing Case Management Minimum three (3) years of Workers' Compensation case management experience. Experience managing cardiac, cardiovascular, or other complex medical claims preferred. Certification in Case Management (CCM) preferred. Experience working with public sector accounts, municipalities, first responder populations, or Florida workers' compensation claims strongly preferred. Additional Notes This position is highly client-facing and requires regular interaction with employer clients, claim stakeholders, and account leadership. Participation in recurring weekly client claims review meetings is required. Occasional travel for client meetings, provider visits, training, or account support may be required. Smoke‑free workplace. Benefits At Davies North America, we are dedicated to supporting the well‑being and future of our qualifying employees. Our comprehensive benefits package includes: 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 Benefit offerings, eligibility, and required employer contributions may vary based on role, classification, and applicable federal, state, and local laws, including those tied to an employee’s primary work location. Where required by law, the Company provides paid sick leave, paid family and parental leave, and other mandated benefits in accordance with applicable state and local requirements. Diversity and Inclusion Davies is dedicated to fostering a diverse and inclusive workplace that embraces a wide range of perspectives and experiences. We believe that diversity of thought is essential for innovation and creativity, and we actively promote an environment where all voices are valued and heard. Compensation Transparency The salary range listed reflects the full compensation band for this role across all locations. Actual compensation will be based on factors such as skills, experience, qualifications, and geographic location, which may impact the final offer. We share ranges to remain transparent and consistent with pay equity practices. Essential Functions The following responsibilities and expectations are considered essential to the successful performance of this role. Reasonable accommodations may be made to enable qualified individuals with disabilities to perform these essential functions. Maintain regular and dependable attendance. Be available and able to perform job responsibilities during established work hours. Background Check & Fair Chance Compliance Any background check or review of criminal history, if applicable to the role, will be conducted only after a conditional offer of employment and in compliance with applicable federal, state, and local laws, including fair‑chance hiring requirements. Massachusetts Notice It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability. AI Policy At Davies, we value authentic conversations and a fair candidate experience. While candidates may use AI and technology tools to prepare for interviews, we expect interview responses and assessments to reflect each individual's own experience, knowledge, and professional judgment. We do not use sites like Facebook, Craigslist, or Telegram to recruit or interview potential employees or contractors. If you have been asked to provide any information through any method other than our career portal, please email us at View email address on click.appcast.io #J-18808-Ljbffr Davies North America