RN Telephonic Nurse Case Manager

About the role

The RN Telephonic Case Manager is responsible for coordinating and managing medical care for injured employees within a Workers’ Compensation environment. This role serves as a clinical resource and advocate, facilitating communication among stakeholders, evaluating treatment plans, monitoring recovery progress, and promoting safe, timely return-to-work outcomes.

Responsibilities

• Manage a caseload of Workers’ Compensation claims through telephonic case management services
• Conduct comprehensive initial and ongoing assessments of injured employees’ medical status, treatment progress, and recovery needs
• Develop, implement, and monitor individualized case management plans to promote optimal medical outcomes
• Review medical records, treatment recommendations, and clinical information to determine appropriateness of care
• Identify barriers to recovery and develop action plans to facilitate progress toward recovery and return-to-work goals
• Monitor adherence to evidence-based treatment guidelines, utilization criteria, and regulatory requirements
• Evaluate treatment plans and document clinical outcomes, recovery progress, and return-to-work milestones
• Act as a liaison among injured employees, employers, healthcare providers, insurers, attorneys, and other authorized stakeholders
• Facilitate effective communication to ensure alignment on treatment plans, recovery goals, and return-to-work expectations
• Establish and maintain strong client relationships through professional service and responsive communication
• Serve as a patient advocate while maintaining compliance with legal, ethical, and regulatory standards
• Address return-to-work capabilities with injured employees and treating providers during ongoing case reviews
• Collaborate with employers and providers to support transitional or modified duty opportunities when appropriate
• Obtain and review job descriptions to assist providers in evaluating work capacity and restrictions
• Promote timely and medically appropriate return-to-work outcomes
• Maintain accurate, timely, and comprehensive case documentation within designated systems
• Ensure compliance with state Workers’ Compensation regulations, client requirements, and company policies
• Protect confidential medical information in accordance with HIPAA and applicable privacy regulations
• Support utilization review processes, including pre-authorization, concurrent review, retrospective review, and medical director referrals as needed
• Monitor provider and vendor performance to ensure quality service delivery
• Identify opportunities for process improvement and operational efficiencies
• Participate in quality assurance, grievance, and other organizational committees as assigned
• Provide clinical education and support to internal staff and stakeholders when appropriate
• Aid in training, mentoring, or guidance of less experienced team members as requested
• Perform other duties as assigned

Requirements

• Minimum three (3) years of clinical nursing experience in one or more of the following areas: Medical-Surgical, Orthopedics, Neurology, Critical Care/ICU, Emergency Room, Occupational Health, Industrial Nursing, Workers’ Compensation case management experience preferred, Telephonic case management experience preferred
• Current, unrestricted Registered Nurse (RN) license in the applicable state(s)
• Ability to maintain active licensure throughout employment
• Strong clinical assessment and critical thinking skills
• Knowledge of Workers’ Compensation processes, regulations, and medical case management principles
• Understanding of evidence-based treatment guidelines and disability management practices
• Ability to manage multiple priorities independently in a fast-paced environment
• Strong organizational and time-management skills
• Excellent verbal and written communication skills
• Ability to build collaborative relationships with diverse stakeholders
• Strong customer service orientation and professionalism
• Proficiency with Microsoft Office applications and case management software systems
• Ability to maintain confidentiality and exercise sound clinical judgment

Skills

• Minimum three (3) years of clinical nursing experience in one or more of the following areas: Medical-Surgical, Orthopedics, Neurology, Critical Care/ICU, Emergency Room, Occupational Health, Industrial Nursing, Workers’ Compensation case management experience preferred, Telephonic case management experience preferred
• Current, unrestricted Registered Nurse (RN) license in the applicable state(s)
• Ability to maintain active licensure throughout employment
• Strong clinical assessment and critical thinking skills
• Knowledge of Workers’ Compensation processes, regulations, and medical case management principles
• Understanding of evidence-based treatment guidelines and disability management practices
• Ability to manage multiple priorities independently in a fast-paced environment
• Strong organizational and time-management skills
• Excellent verbal and written communication skills
• Ability to build collaborative relationships with diverse stakeholders
• Strong customer service orientation and professionalism
• Proficiency with Microsoft Office applications and case management software systems
• Ability to maintain confidentiality and exercise sound clinical judgment

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 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.

Pay

$75,000 - $80,000 / year

Schedule

N/A