Davies North America

Global insurance professional services and tech

Telephonic Nurse Case Manager

Medical, Clinical & VeterinaryUpdated on Nov 13

Full-timeRemote in USA$78k - $83k /yr

About the Job

Requirements

Registered Nurse (RN) with an active and unrestricted license.
At least 3 years of clinical nursing experience in medical-surgical, orthopedic, neurological, ICCU, industrial, or occupational nursing.
At least 1 year of Florida workers' compensation or Florida occupational health experience.
Strong clinical assessment and decision-making skills.
Knowledge of medical case management practices within workers' compensation programs.

Responsibilities

Manage and make independent decisions on medical claims.
Monitor, analyze, evaluate, and coordinate timely, cost-effective medical treatment and other health services for injured employees to support an appropriate return to work when medically indicated.
Manage care throughout the continuum of services to achieve high-quality medical care in a cost-effective and timely manner.
Perform ongoing assessments of injured employees' recovery to ensure quality care, reduce recovery time, and minimize the effects of injury.
Perform telephonic case-management activity on workers' compensation cases according to performance standards required by the State of Florida.
Coordinate and monitor medical treatment for injured workers involved in workers' compensation claims.
Review medical records, treatment plans, and diagnostic reports to assess the appropriateness of care.
Provide clinical recommendations regarding treatment plans, medical progress, and anticipated recovery timelines.
Communicate with treating physicians and medical providers to clarify treatment plans and facilitate appropriate care.
Partner with claims adjusters to provide clinical insight that supports claim evaluation and resolution.
Assist adjusters in understanding medical conditions, treatment plans, and disability status.
Participate in claim reviews and strategy discussions for complex or high-exposure claims.
Work with employers and injured workers to support modified-duty and return-to-work opportunities.
Evaluate functional capacity and work restrictions in collaboration with treating providers.
Monitor treatment plans to ensure care is reasonable, necessary, and aligned with evidence-based guidelines.
Maintain detailed and accurate documentation of case-management activities.
Prepare case summaries, progress reports, and clinical updates for claims teams and stakeholders.

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.

What's in Store
We are on the lookout for a Telephonic Nurse Case Manager. As the NCM, you will be responsible for the management and independent decision making on medical claims. You will monitor, analyze, evaluate and coordinate the delivery of high quality, timely, cost effective medical treatment and other health services as needed by an injured employee to promote an appropriate, prompt return to work when medically indicated. You will manage all care throughout the continuum of services in order to achieve the highest level of quality medical care in the most cost effective and timely manner possible. You will perform ongoing assessments of the injured employee’s recovery to ensure high quality of care, reduce recovery time and minimize the effects of injury.

Responsible for performing Telephonic Case-Management activity on Workers’ Compensation cases according to parameters identified/required performance standards per the State of Florida.

Coordinate and monitor medical treatment for injured workers involved in workers’ compensation claims.
Review medical records, treatment plans, and diagnostic reports to assess the appropriateness of care.
Provide clinical recommendations regarding treatment plans, medical progress, and anticipated recovery timelines.
Communicate with treating physicians and medical providers to clarify treatment plans and facilitate appropriate care.
Partner closely with claims adjusters to provide clinical insight that supports claim evaluation and resolution.
Assist adjusters in understanding medical conditions, treatment plans, and disability status.
Participate in claim reviews and strategy discussions for complex or high-exposure claims.
Work with employers and injured workers to support modified duty and return-to-work opportunities.
Evaluate functional capacity and work restrictions in collaboration with treating providers.
Monitor treatment plans to ensure medical care is reasonable, necessary, and aligned with evidence-based guidelines.
Maintain detailed and accurate documentation of case management activities.
Prepare case summaries, progress reports, and clinical updates for claims teams and stakeholders.

Registered Nurse (RN) with active and unrestricted license
3+ years of clinical nursing experience required (medical-surgical, orthopedic, neurological, ICCU, industrial or occupational)
1 year of FL workers comp or FL occupational health required.
Strong clinical assessment and decision-making skills.
Knowledge of medical case management practices within workers’ compensation programs.
Excellent communication and collaboration skills.

About the Company

Davies North America

Global insurance professional services and tech

Davies North America is a global professional services and technology company that began in the UK as an insurance claims manager. It now provides technology, consulting, and legal solutions to clients in regulated industries, including insurance, through managed services, outsourcing, and advisory offerings. The company grows by acquiring other businesses to expand its geographic reach and service capabilities. Its goal is to become a global leader in professional services and technology for regulated industries, particularly in markets like the US, Canada, and Bermuda.

Company size: 5,001-10,000
Company stage: Debt Financing
Total funding: $363M
Headquarters: London, United Kingdom
Founded: 1968

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