Telephonic Nurse Case Manager

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

• 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

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.