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.

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.

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.