RN Telephonic Nurse Case Manager
Permanent - Full Time $80,000 - $85,000 / yearJob Overview
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 seeking an experienced RN Telephonic Nurse Case Manager to join our growing Workers’ Compensation team. In this role, you will be responsible for independently managing medical claims, ensuring high-quality, cost-effective medical treatment, and facilitating an appropriate and timely return to work for injured employees.
The RN Telephonic Nurse Case Manager is responsible for overseeing and managing Workers’ Compensation medical claims through clinical assessment, care coordination, and proactive communication. This role ensures injured employees receive timely, quality medical care while driving cost-effective outcomes and supporting medically appropriate return-to-work plans. The Nurse Case Manager performs telephonic case management and provides ongoing evaluation throughout the continuum of care.
Key Responsibilities
- Provide telephonic case management for Workers’ Compensation claims focused on clinical appropriateness, cost-effective care, and timely return-to-work.
- Facilitate communication between injured workers, employers, representatives, providers, insurers, and managed care organizations to ensure effective coordination and excellent customer service.
- Build and maintain strong relationships with client contacts; act in accordance with company policies and client expectations.
- Conduct clinical assessments following initial contact to determine recovery needs and care requirements.
- Deliver consistent, ongoing education to injured employees and document all communication appropriately.
- Identify recovery barriers and develop actionable plans to overcome them.
- Review and assess medical records, treatment updates, and provider reports.
- Monitor provider performance and ensure appropriate utilization of medical services.
- Develop, track, and adjust case management care plans as needed.
- Document all interviews, medical data, and communications within the case management system.
- Assess and address return-to-work capabilities at each medical evaluation; obtain and review job descriptions when necessary.
- Manage cases according to state guidelines, clinical protocols, and account requirements to ensure continuity of care.
- Evaluate treatment plans, track outcomes, and ensure adherence to evidence-based guidelines and disability duration standards (e.g., ODG).
- Proactively manage the case using all appropriate tools and resources.
- Develop alternative treatment strategies when indicated.
- Initiate utilization review processes when needed (e.g., pre-certification, concurrent review, medical director review).
- Anticipate health needs during case management and support patient engagement in recovery.
- Maintain strict confidentiality and comply with all legal and regulatory requirements.
- Serve as a patient advocate and uphold professional and ethical standards.
- Participate in committees such as Quality Assurance or Grievance Review as assigned.
- May negotiate provider fees or channel services to preferred vendors.
- May train claims staff on case management opportunities or mentor junior team members.
- Perform other duties as assigned.
Skills, knowledge & expertise
- Registered Nurse (RN) with minimum 3 years of clinical experience (e.g., medical-surgical, orthopedics, neurology, ICCU, ER, occupational health, or similar).
- 3+ years of Workers’ Compensation experience.
- Proof of current, valid state RN licensure.
- Case management experience preferred; Workers’ Compensation experience strongly desired.
- Knowledge of current clinical trends, case management standards, and regulatory updates.
- Ability to work independently with strong self-direction.
- Proficiency with computers, case management systems, and business software.
- Excellent written and verbal communication skills.
- Strong customer service focus and ability to build rapport with multiple stakeholders.
- Team-oriented with reliable attendance and professionalism.