RN Telephonic Nurse Case Manager

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.

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.

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.

regulations, client

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.

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.

, 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.