Telephonic Nurse Case Manager

About Us

At Davies, we get it... you are not just looking for a job, you are looking to build a life and a career. We believe in our people and realize that our success is a direct result of creating a learning atmosphere, leadership opportunities, and promoting from within. We believe that engaging in corporate social activities and working together as a team is a vital part of the Davies culture.

With a multinational global team, Davies Group is a specialist professional services and technology firm working in partnership with leading insurance, highly regulated, and global businesses. At Davies Group, we help clients to manage risk, operate core business processes, and to transform and grow. We deliver operations, consulting and technology solutions across the risk and insurance value chain, including excellence in claims, underwriting, distribution, regulation, customer experience, human capital, transformation, and change management. 

Are you looking for a company that is Dynamic and Innovative where the employees are Connected and Succeed Together? If so, Davies may just be the right choice for you.

Job Overview 

Davies Claims North America is looking for an experienced Telephonic Nurse Case Manager to manage Workers’ Compensation claims ensuring timely and appropriate medical care is provided to injured workers while supplying medical information and making recommendations for compensability of claims. Reporting to the Nurse Case Manager Supervisor, you will telephonically screen and manage workers’ compensation medical claims, review medical documentation, prepare written correspondence, and communicate with physicians regarding major contributing causes of medical conditions as it relates to the reported accident.

To be successful in this role, you must demonstrate high-level attention to detail and problem-solving skills, strong organizational skills with the ability to multi-task and prioritize with excellent organization and documentation, as well as possess proven critical thinking skills while exhibiting analysis and judgement with sound decision making abilities. You must possess a valid Florida Registered Nurse license and must have 3 or more years of hospital, orthopedic, and/or Workers’ Compensation experience. Additionally, you will need to be proactive, independent, and take initiative with consistent follow through while exhibiting discretion with sensitive and confidential information. 

This role is a full-time, in-office position based in Jacksonville, FL, and may require occasional travel for claim reviews.

Responsibilities and Duties

• Triage newly acquired claims to determine severity of reported injuries
• Provide medical information and make recommendations for compensability of claims
• Initiate contact with injured worker regarding medical management of the claim
• Work with medical providers to provide medical management to injured worker
• Review medical documentation, prepare written correspondence, and communicate with physicians regarding major contributing cause of medical condition as it relates to the reported accident
• Monitor medical treatment to ensure medical protocol is within recognized parameters
• Promptly authorize causally related medical services prescribed
• Coordinate light duty availability with medical providers and employers
• Communicate work status changes in a timely manner
• Prepare and approve pre-certifications
• Assist with medical management to obtain MMI
• Maintain working knowledge of Workers’ Compensation Statutes and Rules and their application
• Convey a positive attitude and teamwork for optimum provision of service to clients
• Review Permanent Impairment Rating for appropriateness
• Exhibit company values of We are Dynamic, We are Innovative, We are Connected, and We Succeed Together
• Perform other duties as assigned

Experience and Qualifications

Required

• Must reside in/around the Jacksonville, FL area
• Possess a valid Florida Registered Nurse license
• Substantial knowledge of medical terminology
• Demonstrate proficiency in Microsoft Office Suite programs
• Ability to travel and/or attend claim reviews as deemed necessary

Preferred

• 3+ years of hospital,