Telephonic Nurse Case Manager

Telephonic Nurse Case Manager Department: Claims Administration & Adjusting Employment Type: Permanent - Full Time Location: Home United States Reporting To: Karen Shaffer Compensation: $80,000 - $90,000 / 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 the clinical management and independent decision-making of catastrophic and complex Workers’ Compensation claims. This role focuses on coordinating specialty medical care, driving cost-effective treatment, and supporting injured employees toward timely and medically appropriate return-to-work outcomes. You will manage care across the full continuum of services, conduct ongoing medical assessments, and ensure compliance with Davies standards, applicable statutes, and jurisdictional guidelines for a multi-state caseload.

Key Responsibilities

• Provide specialized telephonic case management for complex and catastrophic Workers’ Compensation claims
• Direct injured employees to appropriate specialty care while maintaining a strong focus on cost containment
• Monitor, analyze, and coordinate high-quality, timely, and cost-effective medical treatment
• Perform comprehensive medical assessments and develop individualized, outcome-focused case management plans
• Facilitate communication among injured workers, employers, adjusters, providers, insurers, and other stakeholders
• Identify barriers to recovery and proactively develop strategies to address them
• Monitor vendor performance and ensure quality delivery of medical services
• Track, evaluate, and document treatment plans, outcomes, and recovery progress in the case management system
• Assess and document return-to-work capabilities and identify modified or alternative duty options when appropriate
• Manage cases in compliance with state-mandated treatment guidelines, utilization criteria, and evidence-based protocols applicable to the date of injury
• Create, edit, and revise correspondence and case documentation
• Utilize utilization review tools when indicated, including prospective, concurrent, and retrospective review, and physician advisor consultation
• Educate injured workers and families on treatment plans, recovery expectations, and care coordination
• Maintain strict confidentiality of all medical and case information in accordance with state and federal regulations
• Serve as a patient advocate while adhering to all legal, ethical, and regulatory standards
• Negotiate provider fees or refer cases to alternate vendors when appropriate and compliant with statutory requirements
• May provide guidance or informal leadership to less-experienced staff
• Perform other duties as assigned

Skills, knowledge & expertise

• Registered Nurse (RN) with 3–5 years of clinical experience in areas such as medical-surgical, orthopedic, neurological, ICU/CCU, industrial, or occupational health
• Must hold one of the following certifications: CCRN, CCM, CDMS, COHN, or COHN-S (required for WC/MCO claims)
• Minimum one (1) year of Workers’ Compensation case management experience
• Current, unrestricted state RN licensure and eligibility for licensure endorsement in other state
• Experience with catastrophic or complex case management and utilization review (preferred)
• Demonstrated ability to balance quality medical care with cost containment strategies
• Strong knowledge of Workers’ Compensation statutes, treatment guidelines, and regulatory requirements
• Ability to work independently and manage a complex, multi-jurisdictional caseload
• Proficiency with case management systems and standard business software
• Excellent written and verbal communication skills
• Strong organizational skills, attention to detail, and customer service orientation
• Team-oriented mindset with dependable attendance

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. Apply tot his job Apply To this Job