Telephonic Nurse Case Manager

Telephonic Nurse Case Manager Department: Claims Administration & Adjusting Employment Type: Permanent - Full Time Location: Home United States Reporting To: Shaunna Jones Compensation: $78,000 - $83,000 / 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. We are looking for a Telephonic Nurse Case Manager (RN), who independently manages medical aspects of Workers’ Compensation claims, ensuring the delivery of high‑quality, timely, and cost‑effective care to injured employees. This role monitors, analyzes, evaluates, and coordinates medical treatment throughout the continuum of care to promote medically appropriate, prompt return‑to‑work outcomes. The Telephonic Case Manager proactively identifies barriers to recovery, develops action plans, and serves as both patient advocate and clinical resource while maintaining compliance with regulatory and client‑specific guidelines. Key Responsibilities Provide telephonic case management for Workers’ Compensation cases. Assess medical appropriateness of treatment plans and coordinate services to optimize recovery and cost efficiency. Develop, implement, and modify individualized case management care plans. Perform ongoing clinical assessments and review medical records to ensure quality and timely care. Identify and address barriers to recovery with proactive action planning. Coordinate communication between injured workers, employers, providers, insurers, and other stakeholders. Promote and document return-to-work capability at each medical milestone. Ensure compliance with state‑mandated treatment guidelines, nationally published protocols, and client requirements. Track outcomes including patient satisfaction, return-to-work progress, and disability duration. Utilize utilization review tools when indicated (pre‑certification, concurrent review, retrospective review, medical director review). Monitor provider and vendor performance to ensure quality and appropriate care delivery. Maintain detailed and accurate documentation within the case management system. Serve as a patient advocate while adhering to all legal, ethical, accreditation, and regulatory standards. Participate in Quality Assurance, Grievance, or other committees as assigned. Provide training or mentorship to claims staff or junior team members as appropriate. Perform additional duties as assigned. Skills, knowledge & expertise Active, unrestricted RN license. Minimum 3 years of clinical experience (medical‑surgical, orthopedic, neurological, ICCU, industrial, ER, or occupational health). Workers’ Compensation case management experience preferred. Strong knowledge of treatment guidelines and utilization management principles. Excellent verbal and written communication skills. Ability to work independently in a remote environment. Proficiency in computer systems and claims/case management software. Telephonic case management experience. Experience applying evidence‑based disability duration guidelines. Prior experience training or mentoring staff. Equal Employment Opportunity & Legal Notices We are committed to a diverse and inclusive workplace and do not discriminate on the basis of race, color, religion, sex, national origin, disability, age, or any other protected characteristic. All employment decisions are made solely on a basis of qualifications, credentials, and business needs. Benefits 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. 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. #J-18808-Ljbffr