Triage Telephonic Nurse Case Manager

ManagerManagerFull TimeRemoteLeadTeam 5,001-10,000H1B SponsorCompany SiteLinkedIn

Location

United States

Posted

4 days ago

Salary

$66K - $67K / year

Seniority

Lead

No structured requirement data.

Job Description

Triage Telephonic Nurse Case Manager

Davies

Role Description 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. - 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. Qualifications - 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. 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.

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