Job Description

Job Description

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 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 5 or more years of 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, hybrid position based in Lakewood Ranch, 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 IW 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

• Possess a valid Florida Registered Nurse license
• 5+ years of Florida Workers’ Compensation claims handling experience
• Substantial knowledge of medical terminology
• Demonstrate proficiency in Microsoft Office Suite programs
• Ability to travel and/or attend claim reviews as deemed necessary

Preferred

• 5+ years of hospital, orthopedic, and/or workers’ compensation experience
• Extensive knowledge of Workers’ Compensation Statutes, Rules, and case law
• NLC licensure (Compact License) highly desirable
• Certified Case Manager designation (CCM)

Knowledge, 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
• Excellent team player with interpersonal skills
• 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
• Display a comfort level working with key people at all levels within an organization

Essential Requirements

• Must have US work rights
• Must speak English
• Possess a valid Florida Registered Nurse license
• 5 or more years of Florida Workers’ Compensation claims handling experience
• Substantial knowledge of medical terminology
• Demonstrate proficiency in Microsoft Office Suite programs
• Ability to travel and/or attend claim reviews as deemed necessary

Other Duties

This job description is not designed to cover or contain a comprehensive listing of activities, duties, or responsibilities required of the individual for this job and is subject to change with or without notice.

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
• Discretionary Time Off (Vacation and Sick Leave) and Paid Holidays
• Life insurance, short term, and long-term disability plans
• Amazing Executive and Senior leadership as well as fabulous teammates

Position Type, Work Environment and Physical Demands

This is a hybrid, full time, salaried, exempt position that predominantly operates onsite and/or 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.

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Job Tags

Holiday work, Permanent employment, Full time, Temporary work, Remote job, Home office,

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