About this role
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. Davies North America is growing! We are currently looking to fill our Cardiac Nurse Care Manager role. The perfect candidate will be responsible for the clinical management and independent decision-making associated with complex cardiac-related workers' compensation claims involving Florida first responders, including law enforcement officers, firefighters, correctional officers, EMTs, paramedics, and other eligible employees covered under Florida's Heart/Lung Bill and related presumptive legislation. You will provide telephonic case management services and clinical oversight throughout the continuum of care for cardiac and cardiovascular-related claims. Monitors, analyzes, evaluates, and coordinates high-quality, evidence-based medical treatment and ancillary services to ensure appropriate medical management, timely recovery, and cost-effective outcomes. Performs ongoing assessments of the injured worker's medical status, treatment progression, functional capacity, and return-to-work potential when medically appropriate. Also serve as a key client-facing clinical resource, partnering closely with claims professionals, employers, attorneys, medical providers, and client stakeholders. Participates in weekly client claims review meetings, providing clinical updates, identifying barriers to claim resolution, discussing treatment plans and outcomes, and making recommendations to support effective claim management and client satisfaction. Provide telephonic nurse case management services for complex cardiac and cardiovascular workers' compensation claims involving Florida first responders. Assess, coordinate, and monitor medical treatment related to cardiac diagnoses, including but not limited to myocardial infarction, coronary artery disease, hypertension-related cardiac conditions, arrhythmias, cardiomyopathy, heart failure, and other cardiovascular disorders. Facilitate communication among injured workers, employers, adjusters, attorneys, medical providers, rehabilitation professionals, and client representatives to ensure coordinated and efficient claim resolution. Serve as a clinical liaison for client accounts, building and maintaining strong professional relationships through proactive communication and exceptional customer service. Participate in weekly client claims review meetings to discuss claim status, treatment progression, barriers to recovery, cost drivers, litigation concerns, return-to-work opportunities, and recommendations for future claim handling. Prepare and present clinical summaries, action plans, and recommendations for client review meetings. Evaluate the medical necessity, appropriateness, and effectiveness of treatment plans using evidence-based medicine, Florida Workers' Compensation guidelines, and relevant cardiac care standards. Conduct comprehensive clinical assessments and develop individualized case management plans based on medical records, provider communications, and injured worker interviews. Identify barriers to medical recovery, claim resolution, and return-to-work outcomes, and develop strategies to address those barriers. Monitor treatment adherence, provider performance, and clinical outcomes to promote quality care and cost containment. Review cardiac diagnostic testing, specialist consultations, medications, procedures, hospitalizations, rehabilitation services, and treatment recommendations. Collaborate with treating physicians and specialists to ensure treatment plans support optimal recovery and functional improvement. Provide ongoing education to injured workers regarding their cardiac condition, treatment plan, lifestyle modifications, medications, and recovery expectations. Ensure all clinical documentation is accurate, timely, and compliant with state regulations, client requirements, and company standards. Maintain comprehensive case notes, treatment summaries, and action plans within the claims management system. Proactively manage claims using appropriate case management tools and resources to achieve favorable medical and financial outcomes. Identify situations requiring utilization review, peer review, medical director consultation, independent medical examinations, or additional clinical interventions. Monitor claim progression and recommend appropriate referrals for vocational rehabilitation, functional capacity evaluations, specialty services, or alternative treatment options when indicated. Evaluate return-to-work capabilities and restrictions in collaboration with treating physicians and employers when medically appropriate. Advocate for quality patient care while balancing regulatory compliance, client expectations, and cost-effective claim management. Participate in quality assurance initiatives, client service activities, and departmental improvement efforts. May assist in training claims professionals and clinical staff regarding cardiac claims management, Florida presumptive legislation, and complex medical issues. May provide mentorship and clinical guidance to less experienced case management staff. Perform other duties as assigned.