Job Overview
We are seeking an experienced Telephonic Nurse Case Manager with a background in Florida Workers’ Compensation to join our growing team. In this role, you will independently manage medical claims, coordinate care, and facilitate timely, cost‑effective treatment for injured workers. The goal is to ensure quality medical outcomes while supporting a safe and medically appropriate return‑to‑work.
This position requires a minimum of 1 year experience in either Florida Occupational Health or Florida Worker's Compensation. Compensation transparency: the salary range reflects the full compensation band for this role across all locations; actual compensation will be based on skills, experience, qualifications, and geographic location.
Key Responsibilities
Provide telephonic case‑management in a workers’ compensation environment, focusing on medical appropriateness of care and cost savings through coordination and utilization of services to achieve return‑to‑work status promptly.
Facilitate communication among employee, employee representative, employer, insurer, health care provider, medical services organization, and authorized rehabilitation consultants to achieve care goals.
Clinically evaluate the recovery needs of an injured employee after the initial contact assessment, incorporating employer and provider information into the plan.
Identify barriers to recovery and formulate an action plan to overcome them.
Provide ongoing assessment of health and medical records.
Monitor and audit health provider licensing and care quality.
Monitor vendor performance to ensure quality service.
Develop case‑management care plans, track, and adjust as needed.
Appropriately document all data from interviews, contacts, and medical records in the computerized system.
Address return‑to‑work capability during each medical evaluation; document in the system.
Manage the file adhering to state‑mandated guidelines and proprietary protocols.
Create, edit, and revise correspondence.
Evaluate treatment plans, document outcomes, and track protocol management.
Manage the file proactively using appropriate case‑management tools.
Develop alternative treatment plans when necessary, accommodating changes in the process.
Utilize appropriate utilization review procedures to identify potential recovery barriers; communicate findings and document accordingly.
Educate patients and families on health needs during case‑management.
Review medical bills for appropriateness and forward to Bill Review/Cost Containment for adjudication.
Maintain patient privacy in accordance with state and federal laws and regulations.
Advocate for patients, adhering to all legal, ethical, and regulatory standards.
Participate in committees such as Grievance, Quality Assurance, and others as directed.
Negotiate fees with providers or refer cases to other vendors as appropriate.
Maintain contracted Florida state performance standards for case management.
Train claims staff on medical case‑management opportunities.
Provide leadership for lower‑graded staff within the department.
Skills, Knowledge & Expertise
Minimum one year’s experience handling Florida Workers’ Compensation case management or Florida Occupational Health (contractual requirement).
Knowledge of current trends, standards, and legal changes.
Self‑directed and able to work independently.
Proficient with personal computer and claim business software.
Strong oral and written communication; team player; good attendance and customer service skills.
Registered Nurse with at least three years of clinical experience in areas such as medical‑surgical, orthopedic, neurological, ICU, industrial, or occupational.
Proof of current State licensure.
Bilingual – fluent English/Spanish preferred.
Benefits
Medical, dental, and vision plans.
401(k) plan with employer matching.
Discretionary Time Off for exempt employees and Paid Time Off for non‑exempt employees.
Paid holidays.
Life insurance and short‑term and long‑term disability plans.
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 actively promote an environment where all voices are valued and heard.