Triage Telephonic Nurse Case Manager

Triage Telephonic Nurse Case Manager Department: Claims Administration & Adjusting Employment Type: Permanent - Full Time Location: Home United States Reporting To: Shaunna Jones Compensation: $66,000 - $67,000 / year Description 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. We’re seeking a Triage Telephonic Nurse Case Manager to join our growing team. This role is ideal for an experienced clinical professional who is passionate about helping injured workers achieve recovery and return-to-work goals while ensuring cost-effective, high-quality medical care. The Triage Telephonic Nurse Case Manager is responsible for the management and independent decision-making of Workers’ Compensation medical claims at the outset of the claim. This role focuses on conducting initial clinical assessments, coordinating appropriate medical care, and facilitating prompt return-to-work outcomes. The Nurse Case Manager will complete the initial assessment and 3-point contact in compliance with State of Florida procedures and emergency protocols.

Key Responsibilities

• Provide triage case management at the initial report of a Workers’ Compensation claim, focusing on medical appropriateness of care and cost efficiency.
• Utilize strong clinical assessment skills to gather all pertinent medical and injury-related information from the injured employee.
• Conduct comprehensive initial evaluations, integrating details from the employee, employer, and provider into an actionable care plan.
• Identify causal relationship issues and notify appropriate parties.
• Facilitate communication among all stakeholders—employee, employer, insurer, providers, and when authorized, rehabilitation consultants.
• Participate in the 24/7/365 intake call center, ensuring timely coordination of care for injured workers.
• Develop and document an initial case management plan and return-to-work strategy.
• Evaluate treatment adherence to state-mandated and evidence-based guidelines.
• Document all assessments, communications, and clinical updates in the electronic claims management system.
• Identify and document barriers to recovery for future case planning.
• Serve as a patient advocate, maintaining compliance with all legal, ethical, and confidentiality standards.
• Monitor clinical outcomes, quality of care, and patient satisfaction.
• May assist in training claims staff on recognizing medical case management opportunities.
• May provide mentorship or guidance to less experienced team members.
• Perform additional duties as assigned.

Skills, knowledge & expertise

• Strong knowledge of medical case management practices, preferably in a Workers’ Compensation setting.
• Excellent communication and interpersonal skills.
• Ability to work independently in a fast-paced, collaborative environment.
• Proficient in computer systems and claims or case management software.
• Demonstrated commitment to patient-centered care and ethical case management practices
• Maintains up-to-date knowledge of current clinical trends, standards, and regulations.
• Registered Nurse (RN) with active state licensure (Florida preferred).
• Minimum of three years of clinical experience in medical-surgical, orthopedic, neurological, industrial, or occupational health settings.
• At least one year of Workers’ Compensation case management experience preferred.
• Strong organizational skills and attention to detail.

Benefits

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 ensure your health and that of your family.
• A 401k plan with employer matching to help you build a secure financial future.
• Our time-off policies, including Discretionary Time Off for exempt employees and Paid Time Off (PTO) package for non-exempt employees, reflect our commitment to promoting a healthy work environment.
• Paid holidays.
• Life insurance and both short-term and long-term disability plans, providing essential financial protection for you and your loved ones.

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. Apply tot his job Apply To this Job