Remote Telephonic Case Manager (LPN/LVN, RN)

Job Overview

  • Clinical License LPN, RN
  • State(s) Nationwide

Full job description

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 teammates are Connected and Succeed Together? If so, Davies may just be the right choice for you.

Job Overview
USIS, Inc., part of Davies Specialty Programs, is looking for a Telephonic Case-Manager for the management of a multi-jurisdictional caseload and independent decision making on medical and surgical claims, with a focus on directing to specialty care inclusive of a focus on cost containment.

Opportunity to work from home. Schedule 9am-6pm Eastern Standard Time.

Responsibilities and Duties:
  • Focus on medical appropriateness of care to 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.
  • Demonstrate experience in the handling of workers’ compensation claims according to applicable statutes and rules.
  • Facilitate communication between the employee, the employee representative, employer, employer representative, insurer, health care provider, the medical services organization and, when authorized, any qualified rehabilitation consultant, to achieve the goals as identified for that case upon review of the file.
  • Clinically evaluate the medical needs of an injured employee after the initial file assessment. Incorporate a case management plan to provide quality care in a cost-effective manner.
  • Monitor vendor performance, ensuring quality service.
  • Develop case-management care plan, track and modify appropriately.
  • Record keeping via computer system.
  • Manage the file adhering to treatment guidelines and utilization criteria as determined by the state-mandated guidelines
  • Create, edit and/or revise correspondence.
  • Manage the file pro-actively, utilizing all appropriate case management tools.
  • Develop alternative treatment plans when necessary. Demonstrate the ability to accommodate changes on the case-management process for delivery of a more refined, efficient and cost-effective system.
  • Communicate the findings determined in utilizing these tools and document appropriately.
  • Serve as a patient advocate adhering to all legal, ethical, and accreditation/regulatory standards.
  • Negotiate fees with providers or channel cases to other vendors as appropriate, with a focus on cost containment, ensuring compliance with applicable statute/rule relevant to the specific date of injury.
  • Perform other duties as needed.

Experience and Qualifications
  • RN with 3-5 years clinical experience (medical-surgical, orthopedic, neurological, ICCU, industrial or occupational).
  • At least 1 years’ experience handling Workers’ Compensation case management.
  • Proof of current State Licensure and eligible for endorsement in all other states.
  • Bi-lingual – fluent English/Spanish helpful.

Knowledge, Skills and Abilities
  • Case-management experience mandatory – at least 1 year Workers’ Comp.
  • Ability to demonstrate strong focus on cost containment to manage cases in most cost-effective way while still ensuring quality medical care.
  • Maintain knowledge of current trends, standards and law changes appropriate to the law at the date of injury.
  • Must be self-directed and able to work independently.
  • Ability to effectively operate a personal computer and related claims and business software.
  • Good communication skills, both oral and written. Team player. Good attendance. Good customer service skills.

Diversity and Inclusion
Davies is committed to being a diverse and inclusive workplace. We welcome candidates of all genders, gender identity and expression, neurodiversity, sexual orientation, disability, physical appearance, body size, race, age, nationality, and belief (or lack thereof).

Rewards and Recognition
We embrace innovation and run an annual competition available for all colleagues to submit their ideas. The top finalists travel to the current year’s competition site where they pitch their ideas to our investors. The winner receives funding to bring their idea to life and the runners up receive a reward for their involvement. Some of our teammates have moved across into brand new positions to further develop their ideas/projects!

Benefits
  • Medical, dental, and vision plans
  • 401k plan with employer matching
  • Paid Time Off, Sick Leave, and Paid Holidays
  • Life insurance, short term, and long-term disability plans
  • Amazing leadership and fabulous teammates

Position Type, Work Environment and Physical Demands
This is a home-based, full time, salaried, exempt position that predominantly operates remotely from a professional home-based office environment routinely using standard office equipment such as computers, phones, printers, photocopiers, and scanners and requires prolonged periods of sitting at a desk while working on a computer. While performing the duties of this job, the individual will be required to regularly hear and talk. This is a largely sedentary role requiring the ability to sit at a desk, reach outward, use a phone, have use of fingers to operate office equipment such as a keyboard, mouse, phone, printer, copier, and to reach above the head, bend, or stand as necessary.

Application Information
Application deadline: May 17, 2024

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