Job Description

Overview Department: Claims Administration & Adjusting Location: Home United States Compensation: $78,000 - $83,000 / year Description Davies North America is part of the global Davies Group, shaping the future by blending technology with professional services in the insurance and regulated sectors. The role is for a Telephonic Nurse Case Manager (RN) who independently manages medical aspects of Workers’ Compensation claims to deliver high-quality, timely, and cost-effective care to injured employees. The Telephonic Case Manager analyzes, coordinates, and monitors medical treatment throughout the continuum of care to promote medically appropriate, prompt return-to-work outcomes. The role identifies barriers to recovery, develops action plans, and serves as patient advocate and clinical resource while maintaining compliance with regulatory and client-specific guidelines. 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 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 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 Benefit offerings, eligibility, and required employer contributions may vary based on role, classification, and applicable federal, state, and local laws, including those tied to an employee’s primary work location. Where required by law, the Company provides paid sick leave, paid family and parental leave, and other mandated benefits in accordance with applicable state and local requirements. 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. Background Check & Fair Chance Compliance Any background check or review of criminal history, if applicable to the role, will be conducted only after a conditional offer of employment and in compliance with applicable federal, state, and local laws, including fair-chance hiring requirements. Massachusetts Notice It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability. #J-18808-Ljbffr Davies North America

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