Candidates with a California RN license are encouraged to apply, though it is not a requirement for consideration.
Key Responsibilities
- Provide telephonic case management for workers’ compensation claims
- Evaluate medical treatment plans for appropriateness and evidence-based care
- Coordinate communication between injured worker, employer, adjuster, and providers
- Develop and update individualized care plans to support recovery and return-to-work
- Identify barriers to recovery and implement action plans to address them
- Monitor medical progress and functional status throughout treatment
- Educate injured workers regarding treatment plans and recovery expectations
- Facilitate return-to-work discussions with providers and employers
- Ensure compliance with state guidelines, clinical protocols, and client requirements
- Utilize utilization review tools when appropriate (pre-certification, concurrent review, retrospective review)
- Document case activity and medical updates in claims systems accurately and timely
- Maintain confidentiality in accordance with HIPAA and regulatory standards
- Support client relationships through professional communication and service excellence
- Participate in quality assurance activities and training as needed
Skills, knowledge & expertise
- Active RN license (compact license preferred)
- 3+ years clinical nursing experience (ER, ICU, Med-Surg, Ortho, Neuro, Occupational, or similar)
- Workers’ Compensation case management experience is preferred but not required
- Ability to independently manage a caseload in a remote environment
- Strong written and verbal communication skills
- Certified Case Manager (CCM) or related certification preferred
- Experience with utilization review processes
- Experience working with multiple jurisdictions or state guidelines
- Understanding of treatment guidelines and disability duration concepts
- Strong critical thinking and clinical assessment abilities
- Ability to build rapport with injured workers and providers
- Effective time management and organization skills
- Proficiency in case management and claims software systems
Benefits
- Medical, dental, and vision plans to ensure your health and that of your family.
- A 401k plan with employer matching to help you build a secure financial future.
- Our time-off policies, including Discretionary Time Off for exempt employees and Paid Time Off (PTO) package for non-exempt employees, reflect our commitment to promoting a healthy work environment.
- Paid holidays.
- Life insurance and both short-term and long-term disability plans, providing essential financial protection for you and your loved ones.
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.
About Davies
We help our clients to manage risk, operate their core business processes, transform and grow. We deliver professional services and technology solutions across the risk and insurance value chain, including excellence in claims, underwriting, distribution, regulation & risk, customer experience, human capital, digital transformation & change management.
Our global team of more than 8,000 professionals operate across ten countries, including the UK & the U.S. Over the past ten years Davies has grown its annual revenues more than 20-fold, investing heavily in research & development, innovation & automation, colleague development, and client service. Today the group serves more than 1,500 insurance, financial services, public sector, and other highly regulated clients.
