[Hiring] Cardiac Telephonic Nurse Case Manager @Davies

Role Description

We are seeking an experienced Cardiac Telephonic Nurse Case Manager to manage Workers' Compensation medical cases involving cardiac conditions and related treatment plans. This role requires a strong clinical background in cardiac care and the ability to evaluate complex cardiovascular diagnoses, treatment plans, procedures, medications, and recovery progress.

• Utilize advanced cardiac clinical knowledge to review, evaluate, and coordinate treatment plans involving cardiovascular conditions, cardiac procedures, and related medical care.
• Monitor recovery progress and treatment outcomes for injured workers with cardiac injuries, diagnoses, or comorbidities.
• Collaborate with treating physicians, cardiologists, healthcare providers, employers, adjusters, and injured workers to support optimal medical and return-to-work outcomes.
• Evaluate medical necessity and appropriateness of cardiac treatment plans utilizing evidence-based treatment guidelines and clinical best practices.
• Identify barriers to recovery specific to cardiac conditions and develop appropriate intervention strategies.
• Educate injured workers regarding cardiac diagnoses, treatment recommendations, medication compliance, lifestyle modifications, and recovery expectations as appropriate.
• Review medical records, treatment plans, diagnostic testing, and provider recommendations.
• Encourage injured worker participation in treatment and recovery plans.
• Evaluate return-to-work capabilities and discuss restrictions with providers and employers.
• Obtain and review job descriptions to assist providers in determining appropriate work capacity.
• Coordinate modified duty and transitional return-to-work opportunities when medically appropriate.
• Adhere to state treatment guidelines, evidence-based protocols, account requirements, and organizational standards.
• Monitor compliance with ODG, ACOEM, state-specific treatment guidelines, and utilization criteria as applicable.
• Identify cases requiring utilization review, physician review, pre-certification, pre-authorization, concurrent review, or retrospective review.
• Track treatment outcomes, disability durations, and return-to-work progress.
• Maintain timely, accurate, and thorough case documentation within electronic case management systems.
• Ensure compliance with HIPAA and all applicable state and federal privacy regulations.
• Serve as a patient advocate while maintaining legal, ethical, and regulatory standards.
• Participate in quality improvement initiatives, client meetings, and team collaboration activities as needed.
• Assist with training, mentoring, and knowledge-sharing opportunities when appropriate.
• Perform additional duties and special projects as assigned.

Qualifications

• Active Registered Nurse (RN) license with proof of current state licensure.
• Minimum of 3 years of clinical nursing experience.
• Minimum of 3 years of Workers' Compensation case management experience preferred.
• Recent cardiac clinical experience is required.
• Cardiac experience may include one or more of the following:
  • Working on a Cardiac Unit or Cardiac Step-Down Unit.
  • Critical Care/ICU experience managing cardiac patients.
  • Experience titrating cardiac drips and monitoring complex cardiac conditions.
  • Employment within a Cardiology Practice or Cardiology Provider Office.
  • Interventional Radiology experience supporting cardiac procedures.
  • Cardiac Catheterization Lab experience.
  • Cardiovascular Case Management experience.
  • Other direct cardiac care experience involving the treatment and management of cardiac patients.
• Strong understanding of cardiac conditions, treatment protocols, procedures, medications, diagnostics, and recovery planning.
• Ability to independently review and interpret medical records, treatment plans, diagnostic studies, and physician recommendations.
• Strong clinical assessment, care coordination, and communication skills.
• Ability to work independently in a telephonic case management environment.

Benefits

• 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.