Triage Nurse Case Manager

Triage Nurse Case Manager

Department: Claims Administration & Adjusting

Employment Type: Permanent - Full Time

Location: Home United States

Reporting To: Wendy Gillmore

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.

What's in Store

We're on the lookout for a Triage Telephonic Case Manager to join our growing team! As a Triage Telephonic Case Manager, you will be responsible for the management and independent decision making on Workers' Compensation medical claims at the outset of the claim. You will perform an initial assessment of the injured worker to ensure high quality of care and reduce recovery time to promote an appropriate, prompt return-to-work, according to parameters identified to meet required performance standards.

This role is a full-time, remote position.

Key Responsibilities

Provide triage case management in a Workers' Compensation environment at the initial report of the claim while focusing on medical appropriateness of care to the injured worker with cost savings by coordination and utilization of all services, ensuring that as soon as medically feasible, return-to-work status is achieved

Utilize keen clinical assessment skills to ascertain all pertinent information from the injured employee to facilitate appropriate care

Clinically evaluate the recovery needs of an injured employee after the initial contact assessment

Incorporate information obtained from the employer and provider into the initial plan

Identify causal relationship issues and document the system notifying all appropriate parties

Participate in the daily functioning of a round-the-clock intake call center, ensuring expedient care to the injured employees and being knowledgeable of all functions of the department

Facilitate communication between the employee, the employee representative, employer, employer representative, insurer, health care provider, and the medical services organization and when authorized, any qualified rehabilitation consultant

Identify barriers to recovery and document for future case planning

Develop initial case-management care plan

Appropriately document all data received from interviews, contacts and medical records in the computerized system

Address the initial return-to-work capability with the injured worker and provider at each medical evaluation and document appropriately in computerized system

Identify when initial treatment does not adhere to treatment guidelines and utilization criteria as determined by the state-mandated guidelines, proprietary and nationally published protocols, as well as account requirements, assuring smooth delivery of services to the injured worker

Create, edit and/or revise correspondence in the system as necessary

Assist with tracking protocol management for appropriate utilization and delivery of medical services; outcomes will be evidenced by patient satisfaction, appropriate delivery and quality of care and timely recovery per evidence-based criteria and clinical guidelines

Manage the file proactively, utilizing all appropriate case management tools

Anticipate health needs during case management process and educate patient and family appropriately while encouraging the injured worker to participate in the recovery plan

Maintain patient privacy by ensuring that all medical records, case specific information and provider specific information are kept in a confidential manner, in accordance with state and federal laws and regulations

Serve as a patient advocate adhering to all legal, ethical and accreditation/regulatory standards

Serve on appropriate committees such as the Quality Assurance and others as directed

May negotiate fees with providers or channel cases to other vendors as appropriate

Perform other duties as requested Skills, knowledge & expertise

Licensed Florida RN (or Compact License) with a minimum of three years of clinical experience (medical-surgical, orthopedic, neurological, ICU, industrial, or occupational)

Workers' Compensation and Case Management experience preferred

Bilingual (Spanish) preferred

Proficiency with Microsoft Office Suite and various other business software programs Other Skills and Abilities:

Proactive, independent, and takes initiative with consistent follow through

Superb communication skills, verbal and written, conducted in a timely manner

Superior time management skills with capability of working with and meeting deadlines

Exceptional capability to multi-task and prioritize with excellent organization and documentation skills in a fast-paced, dynamic work environment

High level attention to detail and problem-solving skills

Capable of working collaboratively and independently with minimal supervision

Exhibit discretion with sensitive and confidential information

Ability to adapt to new technologies quickly

Customer service orientation, with a track record of resolving client issues efficiently and effectively

Proven ability to mentor and train team members, fostering a collaborative and productive work environment Benefits

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 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

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.