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.

Davies North America is seeking an experienced Triage Telephonic Case Manager (RN) to join our Workers' Compensation managed care team. This role is responsible for providing clinical triage and telephonic case management services at the initial report of injury, ensuring injured employees receive appropriate, timely medical care while promoting recovery and return-to-work outcomes.

The ideal candidate is a Registered Nurse with strong clinical assessment skills, workers' compensation knowledge, and the ability to make independent decisions in a dynamic, fast-paced environment. This position plays a critical role in the early intervention process, helping coordinate care, identify barriers to recovery, and advocate for injured workers while balancing client and regulatory requirements.

Shift Availability: We currently have three openings available for this position, including two daytime shifts (9:00 AM - 6:00 PM) and one evening shift (2:00 PM - 11:00 PM) . Candidates must be able to work one of these schedules based on business needs and availability.

Key Responsibilities

• Provide telephonic triage case management services at the onset of workers' compensation claims.
• Conduct comprehensive clinical assessments of injured employees at the time of injury and determine appropriate levels of care.
• Complete initial evaluations and required three-point contacts in accordance with state requirements and established protocols.
• Assess medical appropriateness of treatment and support timely access to care.
• Develop and implement initial case management care plans based on assessment findings.
• Coordinate communication among injured workers, employers, providers, claims professionals, and other stakeholders.
• Identify potential barriers to recovery and document findings for future case planning.
• Evaluate return-to-work capabilities and facilitate modified duty discussions when appropriate.
• Monitor treatment plans for compliance with state guidelines, evidence-based protocols, and client-specific requirements.
• Identify potential causation concerns and communicate findings to appropriate parties.
• Accurately document all assessments, contacts, medical information, and case activities within the claims management system.
• Serve as a patient advocate while maintaining compliance with all legal, ethical, and regulatory requirements.
• Support utilization management efforts through coordination of appropriate medical services and resources.
• Participate in quality assurance initiatives and departmental projects as assigned.
• Provide education and support to injured workers and their families throughout the recovery process.
• Assist in training claims personnel regarding medical case management opportunities and clinical considerations.
• Serve as a resource and mentor to team members as needed.

Skills, knowledge & expertise

• Current unrestricted Registered Nurse (RN) license.
• Minimum of 3 years of clinical nursing experience in one or more of the following:
  • Medical-Surgical
  • Orthopedics
  • Neurology
  • Critical Care/ICU
  • Occupational Health
  • Industrial Nursing
• Strong clinical assessment and critical thinking skills.
• Excellent verbal and written communication skills.
• Ability to work independently and make sound clinical decisions.
• Proficiency with Microsoft Office Suite and healthcare or claims-related systems.
• Ability to manage multiple priorities in a fast-paced environment while maintaining attention to detail.

• Previous Workers' Compensation case management experience.
• Telephonic case management experience.
• CCM (Certified Case Manager) designation or progress toward certification.
• Experience in utilization review or managed care environments.
• Familiarity with state workers' compensation regulations and treatment guidelines.
• Experience working in a call center or high-volume intake environment.
• Bilingual skills are a plus.

• Clinical Assessment & Triage
• Workers' Compensation Case Management
• Return-to-Work Coordination
• Medical Documentation Review
• Care Coordination
• Customer Service Excellence
• Critical Thinking & Problem Solving
• Communication & Relationship Building
• Time Management & Organization
• Patient Advocacy
• Regulatory Compliance
• Independent Decision Making

Equal Employment Opportunity & Legal Notices

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.

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 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.

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 Notice It 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.

AI Policy At Davies, we value authentic conversations and a fair candidate experience. While candidates may use AI and technology tools to prepare for interviews, we expect interview responses and assessments to reflect each individual's own experience, knowledge, and professional judgment.
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