RN Telephonic Nurse Case Manager
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Job Location:
Yearly Salary:
Posted on:
3 days ago
Vacancies:
1 Vacancy
Job Summary
Our Story
Imagine being part of a team thats not just shaping the future but actively driving it. At Davies North America were 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
Benefits
At Davies North America we are dedicated to supporting the wellbeing 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
- Timeoff policies including Discretionary Time Off (DTO) for exempt employees and Paid Time Off (PTO) for nonexempt employees
- Paid holidays
- Life insurance and shortterm and longterm 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 employees 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.
Background Check & Fair Chance Compliance
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.
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 fairchance 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.
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.
Required Experience:
Manager
