Telephonic Nurse Case Manager

Overview

Davies North America is 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.

Department: Claims Administration & Adjusting
Location: Home United States
Compensation: $80,000 - $90,000 / year

• 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

• 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

• 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
• Discretionary Time Off for exempt employees and Paid Time Off (PTO) for non-exempt employees
• Paid holidays
• Life insurance and both short-term and long-term disability plans

Davies is dedicated to fostering a diverse and inclusive workplace that embraces a wide range of perspectives and experiences. We actively promote an environment where all voices are valued and heard.

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.