Telephonic Nurse Case Manager (Remote)

Department: Claims Administration & Adjusting

Employment Type: Permanent - Full Time

Location: Home United States

Reporting To: Karen Shaffer

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.

What's in Store We're on the lookout for a Telephonic Nurse Case Manager to join our growing team! As a Telephonic Nurse Case Manager, you will be responsible for monitoring, evaluating and coordinating the delivery of high quality, timely, cost-effective medical treatment and other health services under Workers' Compensation law. Reporting to the Case Management Supervisor, you will also perform ongoing assessments of the injured employee's recovery to ensure high quality of care, reduce recovery time and minimize the effects of injury.

This role is a full-time, home-based position.

Key Responsibilities

• Providing telephonic case management in a Workers' Compensation environment while focusing on medical appropriateness of care to injured worker with cost savings by coordination and utilization of all services, ensuring that as soon as medically feasible, return-to-work status is achieved, along with increase in productivity
• Facilitating communication between the employee, the employee representative, employer, employer representative, insurer, health care provider, the medical services organization and when authorized, any qualified rehabilitation consultant, to achieve the goals
• Ensuring appropriate, progressive education is provided to the injured employee in a consistent manner while documenting in the system
• Identifying barriers to recovery and formulating a plan to overcome the barriers
• Clinically evaluating the recovery needs of an injured employee after the initial contact assessment and providing ongoing assessment of health and medical records
• Evaluating treatment plans while tracking and modifying appropriately, and documenting outcomes; developing alternative treatment plans as necessary
• Tracking protocol management for appropriate utilization and delivery of medical services
• Serving as a patient advocate adhering to all legal, ethical and accreditation/regulatory standards
• Exhibit company values of We are Dynamic, We are Innovative, We are Connected, and We Succeed Together
• Perform other duties as assigned

Skills, knowledge & expertise

• RN with 3-5 years clinical experience (medical-surgical, orthopedic, neurological, ICCU, industrial or occupational)
• Must possess one of the following certifications: CCRN, CCM, CDMS, COHN, COHN-S if managing a WC/MCO claim
• At least 1 years' experience handling Workers' Compensation case management
• Proof of current State Licensure and eligible for endorsement in all other states
• Bi-lingual - fluent English/Spanish helpful
• Case-management experience mandatory - at least 1 year Workers' Compensation
• Field case or catastrophic case management and utilization review experience is highly preferred
• Ability to demonstrate strong focus on cost containment to manage cases in most cost-effective way while still ensuring quality medical care
• Maintain knowledge of current trends, standards and law changes appropriate to the law at the date of injury
• Must be self-directed and able to work independently
• Ability to effectively operate a personal computer and related claims and business software.
• Good communication skills, both oral and written
• Must be a team player with superb customer service skills

Equal Employment Opportunity & Legal Notices

Benefits

At Davies North America, we are dedicated to supporting the well-being 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
• 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.

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.

Essential Functions
The following responsibilities and expectations are considered essential to the successful performance of this role. Reasonable accommodations may be made to enable qualified individuals with disabilities to perform these essential functions.

• Maintain regular and dependable attendance.
• Be available and able to perform job responsibilities during established work hours.

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.

AI Policy At Davies, we value authentic conversations and a fair candidate experience. While candidates may use AI and technology tools to prepare for interviews, we expect interview responses and assessments to reflect each individual's own experience, knowledge, and professional judgment.
We do not use sites like Facebook, Craigslist, or Telegram to recruit or interview potential employees or contractors. If you have been asked to provide any information through any method other than our career portal, please email us at recruitment@davies-group.com