Telephonic Nurse Case Manager (Remote)

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

• 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

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

About
We are a specialist professional services and technology firm, working in partnership with leading insurance, highly regulated and global businesses.We help our clients to manage risk, operate their core business processes, transform and grow. We deliver professional services and technology solutions across the risk and insurance value chain, including excellence in claims, underwriting, distribution, regulation & risk, customer experience, human capital, digital transformation & change management.Our global team of more than 8,000 professionals operate across ten countries, including the UK & the U.S. Over the past ten years Davies has grown its annual revenues more than 20-fold, investing heavily in research & development, innovation & automation, colleague development, and client service. Today the group serves more than 1,500 insurance, financial services, public sector, and other highly regulated clients.