Triage Telephonic Nurse Case Manager

Our StoryImagine 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.
Davies North America is seeking a Triage Telephonic Case Manager (RN) to join our medical management team. In this role, you will provide clinical triage and telephonic case management at the initial report of a Workers’ Compensation claim, ensuring injured employees receive appropriate and timely medical care while supporting early return-to-work outcomes.This position requires strong clinical assessment skills, independent decision-making, and excellent communication to coordinate care between injured workers, employers, healthcare providers, and claims professionals.

Key Responsibilities

• Conduct initial triage and telephonic case management at the outset of Workers’ Compensation claims.
• Perform clinical assessments of injured workers to determine appropriate medical care and treatment pathways.
• Complete initial assessment and required three-point contact in accordance with State of Florida procedures and emergency protocols.
• Develop an initial case management care plan based on clinical findings and information obtained from the injured worker, employer, and medical provider.
• Identify potential causation concerns or barriers to recovery and document findings appropriately.
• Facilitate communication between injured workers, employers, claims professionals, healthcare providers, and rehabilitation specialists.
• Monitor treatment plans to ensure adherence to state-mandated treatment guidelines and evidence-based medical protocols.
• Address initial return-to-work capabilities with injured workers and providers, documenting updates in the case management system.
• Maintain accurate and timely documentation of all contacts, interviews, and medical information in the claims management system.
• Identify opportunities for cost-effective medical management and appropriate utilization of services.
• Educate injured workers and their families about recovery expectations and care plans.
• Maintain strict patient confidentiality and compliance with state and federal healthcare regulations.
• Serve as a patient advocate, ensuring quality care and adherence to ethical and regulatory standards.
• Participate in quality assurance initiatives, committees, and department activities as required.
• Assist with training claims staff on identifying medical case management opportunities, as needed.

Skills, knowledge & expertise

• Registered Nurse (RN) with an active and unrestricted state license
• Minimum of 3 years of clinical nursing experience (medical-surgical, orthopedic, neurological, ICU/CCU, occupational health, or related specialty).
• Workers’ Compensation case management experience preferred.
• Prior telephonic case management or triage experience preferred.
• Strong understanding of clinical documentation and patient advocacy principles.
• Strong clinical assessment and triage skills in a Workers’ Compensation or occupational health environment.
• Knowledge of Workers’ Compensation medical case management practices and treatment guidelines.
• Ability to identify barriers to recovery and develop appropriate care strategies.
• Excellent verbal and written communication skills, with the ability to work collaboratively with multiple stakeholders.
• Strong organizational and documentation skills with attention to detail.
• Ability to work independently and manage multiple priorities in a fast-paced environment.
• Proficiency with computer systems, case management software, and Microsoft Office applications.
• Commitment to high-quality patient care, confidentiality, and regulatory compliance.

Equal Employment Opportunity & Legal Notices

BenefitsAt 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 InclusionDavies 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 NoticeIt 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.
We do not use sites like Facebook, Craigslist, or Telegram to recruit or interview potential employees or contractors. If you have been asked to provide any information through any method other than our career portal, please email us at recruitment@davies-group.com

Originally posted on Himalayas