Team Lead Telephonic Nurse Case Manager

Team Lead Telephonic Nurse Case Manager

• Department: Claims Administration & Adjusting
• Employment Type: Permanent - Full Time
• Location: Lakewood Ranch, FL
• Reporting To: Robin Martin
• Compensation: $78,000 - $80,000 / year

Description

Our StoryImagine 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.
We are seeking an experienced Team Lead to join our Telephonic Case Management (TCM) team. In this role, you will support the Supervisor with both administrative and operational functions while also managing a partial caseload of Workers’ Compensation claims. This position requires strong clinical expertise, leadership ability, and a commitment to delivering high-quality, cost-effective care for injured workers. 

Key Responsibilities

• Lead and support the Telephonic Nurse Case Management (TNCM) team, ensuring smooth coordination and communication.
• Act as a preceptor for training new TNCMs; provide coaching and retraining to maintain quality and productivity.
• Assist the Supervisor with daily administrative tasks, including:
• Staffing notifications in the Supervisor’s absence.
• Facilitating team meetings as assigned.
• Supporting workflow management (diaries, emails, etc.).
• Reviewing MCC letters, pre-certifications, and periodic case reviews (30/60/90 days).
• Addressing compliance issues with TNCM diaries.
• Providing coverage and support during staff absences.
• Reporting incidents or changes involving staff, providers, networks, or clients.
• Assisting with IT issues and submitting support tickets when needed.
• Reminding staff of meetings and CEU requirements.
• Participating in claim reviews and other meetings as requested.
• Conducting monthly audits and reporting findings to the Supervisor.
• Participating in interviews and offering input on performance evaluations.
• Deliver telephonic case management services focused on medical appropriateness and cost-effective care.
• Coordinate communication among injured workers, clients, healthcare providers, and authorized consultants.
• Conduct clinical evaluations and develop individualized recovery plans.
• Identify and address barriers to recovery; revise care plans as needed.
• Monitor medical records and provider performance for quality and compliance.
• Document all case-related information accurately in the claims system.
• Facilitate return-to-work planning and verify disability status using approved guidelines.
• Ensure adherence to treatment protocols, utilization criteria, and account-specific requirements.
• Evaluate treatment outcomes and adjust plans to improve recovery and satisfaction.
• Utilize utilization review tools (e.g., pre-certification, concurrent review) to identify and resolve recovery barriers.
• Educate injured workers and families on recovery plans and encourage active participation.
• Review medical bills for relatedness.
• Maintain confidentiality and comply with all legal and regulatory standards.
• Advocate for patients while upholding ethical and accreditation standards.
• Negotiate provider fees or redirect cases to appropriate vendors when necessary.
• Meet contracted State of Florida performance standards for case management.
• Train claims staff on identifying case management opportunities.
• Provide leadership and guidance to junior staff as needed.
• Perform other duties as assigned.

Skills, Knowledge & Expertise

• Minimum of 1 year of Florida Workers’ Compensation case management experience required.
• Demonstrated knowledge of current trends, standards, and regulatory changes in case management and Workers’ Compensation.
• Ability to work independently with minimal supervision; self-directed and proactive.
• Proficiency with personal computers and claims/business software.
• Strong oral and written communication skills.
• Excellent customer service skills; dependable team player with consistent attendance.
• Skilled in performing team lead functions efficiently and respectfully, supporting the Supervisor and fostering a positive team culture aligned with company values.

Benefits

BenefitsAt 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 InclusionDavies 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.