RN Telephonic Nurse Case Manager Department:

Claims Administration & Adjusting Employment Type:

Permanent -

Full Time Location:

Home United States Reporting To:

Vanessa Neuner Compensation:

$75,000 - $80,000 / year 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. The RN Telephonic Case Manager is responsible for coordinating and managing medical care for injured employees within a Workers' Compensation environment. This role serves as a clinical resource and advocate, facilitating communication among stakeholders, evaluating treatment plans, monitoring recovery progress, and promoting safe, timely return-to-work outcomes. Through proactive case management, the Telephonic Case Manager ensures quality healthcare delivery while supporting cost-effective claim resolution and positive customer experiences. Key Responsibilities Manage a caseload of Workers' Compensation claims through telephonic case management services Conduct comprehensive initial and ongoing assessments of injured employees' medical status, treatment progress, and recovery needs Develop, implement, and monitor individualized case management plans to promote optimal medical outcomes. Review medical records, treatment recommendations, and clinical information to determine appropriateness of care. Identify barriers to recovery and develop action plans to facilitate progress toward recovery and return-to-work goals. Monitor adherence to evidence-based treatment guidelines, utilization criteria, and regulatory requirements. Evaluate treatment plans and document clinical outcomes, recovery progress, and return-to-work milestones. Act as a liaison among injured employees, employers, healthcare providers, insurers, attorneys, and other authorized stakeholders. Facilitate effective communication to ensure alignment on treatment plans, recovery goals, and return-to-work expectations. Establish and maintain strong client relationships through professional service and responsive communication. Serve as a patient advocate while maintaining compliance with legal, ethical, and regulatory standards. Address return-to-work capabilities with injured employees and treating providers during ongoing case reviews. Collaborate with employers and providers to support transitional or modified duty opportunities when appropriate. Obtain and review job descriptions to assist providers in evaluating work capacity and restrictions. Promote timely and medically appropriate return-to-work outcomes. Maintain accurate, timely, and comprehensive case documentation within designated systems. Ensure compliance with state Workers' Compensation regulations, client requirements, and company policies. Protect confidential medical information in accordance with HIPAA and applicable privacy regulations. Support utilization review processes, including pre-authorization, concurrent review, retrospective review, and medical director referrals as needed. Monitor provider and vendor performance to ensure quality service delivery. Identify opportunities for process improvement and operational efficiencies. Participate in quality assurance, grievance, and other organizational committees as assigned. Provide clinical education and support to internal staff and stakeholders when appropriate. Assist with training, mentoring, or guidance of less experienced team members as requested. Perform other duties as assigned. Skills, knowledge & expertise Minimum three (3) years of clinical nursing experience in one or more of the following areas: Medical-Surgical Orthopedics Neurology Critical Care/ICCU Emergency Room Occupational Health Industrial Nursing Workers' Compensation case management experience preferred. Telephonic case management experience preferred. Current, unrestricted Registered Nurse (RN) license in the applicable state(s). Ability to maintain active licensure throughout employment. Strong clinical assessment and critical thinking skills. Knowledge of Workers' Compensation processes, regulations, and medical case management principles. Understanding of evidence-based treatment guidelines and disability management practices. Ability to manage multiple priorities independently in a fast-paced environment. Strong organizational and time-management skills. Excellent verbal and written communication skills. Ability to build collaborative relationships with diverse stakeholders. Strong customer service orientation and professionalism. Proficiency with Microsoft Office applications and case management software systems. Ability to maintain confidentiality and exercise sound clinical judgment. Minimal travel may be required based on business needs. 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. 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. 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