[Hiring] Telephonic Nurse Case Manager @Davies

Role Description

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.

Key Responsibilities

• 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.

Qualifications

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

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.