RN Telephonic Nurse Case Manager

RN Telephonic Nurse Case Manager Department:

Claims Administration & Adjusting Employment Type:

Permanent -

Full Time Location:

Home United States Reporting To:

Julie Feltmann Compensation:

$73,000 - $75,000 / 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 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. Key Responsibilities 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 Skills, knowledge & expertise Active RN license (compact license preferred) 3+ years clinical nursing experience (ER, ICU, Med-Surg, Ortho, Neuro, Occupational, or similar) Workers' Compensation case management experience is preferred but not required Ability to independently manage a caseload in a remote environment Strong written and verbal communication skills Certified Case Manager (CCM) or related certification preferred Experience with utilization review processes Experience working with multiple jurisdictions or state guidelines Understanding of treatment guidelines and disability duration concepts Strong critical thinking and clinical assessment abilities Ability to build rapport with injured workers and providers Effective time management and organization skills Proficiency in case management and claims software systems Benefits 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 ensure your health and that of your family. A 401k plan with employer matching to help you build a secure financial future. Our time-off policies, including Discretionary Time Off for exempt employees and Paid Time Off (PTO) package for non-exempt employees, reflect our commitment to promoting a healthy work environment. Paid holidays. Life insurance and both short-term and long-term disability plans, providing essential financial protection for you and your loved ones. 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.