RN Telephonic Nurse Case Manager

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.

The Telephonic Nurse Case Manager is responsible for managing workers’ compensation medical cases through telephonic case management. This role coordinates care, evaluates treatment plans, and facilitates communication between all parties to ensure injured employees receive appropriate, timely, and cost-effective medical treatment. You will independently manage cases across the continuum of care from initial assessment through recovery and return-to-work, while identifying barriers to recovery and promoting optimal outcomes. Candidates with a California RN license are encouraged to apply, though it is not a requirement for consideration.

Provide telephonic case management for workers’ compensation claims Evaluate medical treatment plans for appropriateness and evidence-based care Coordinate communication between injured worker, employer, adjuster, and providers Develop and update individualized care plans to support recovery and return-to-work Identify barriers to recovery and implement action plans to address them Monitor medical progress and functional status throughout treatment Educate injured workers regarding treatment plans and recovery expectations Facilitate return-to-work discussions with providers and employers Ensure compliance with state guidelines, clinical protocols, and client requirements Utilize utilization review tools when appropriate (pre-certification, concurrent review, retrospective review) Document case activity and medical updates in claims systems accurately and timely Maintain confidentiality in accordance with HIPAA and regulatory standards Support client relationships through professional communication and service excellence Participate in quality assurance activities and training as needed