Telephonic Case Manager I

CorVel Career Site•Franklin, TN

7d•Remote

About The Position

The Telephonic Case Manager coordinates resources and develops cost-effective, personalized care plans for ill or injured individuals. The role supports quality treatment and, when appropriate, a timely return to work. It uses clinical expertise to assess whether current treatment plans are appropriate for the patient’s medical and physical condition. The Case Manager communicates directly with treating physicians to evaluate and recommend alternative care options when needed, and explains medical conditions and treatment plans to patients, family members, and adjusters. The position also supports the objectives of the Case Management department and CorVel. This is a remote role. The Case Manager provides medical case management through coordination with the patient, physician, other health care providers, employer, and referral source. Responsibilities include assessing, planning, implementing, and evaluating patient progress; evaluating treatment plans for appropriateness, medical necessity, and cost effectiveness; and using medical and nursing knowledge to discuss current or alternate treatment plans with physicians. The role makes medical recommendations to the payer, implements care arrangements such as durable medical equipment and nursing services, devises cost-effective strategies for medical care, and prepares organized reports within specified timeframes. The minimum productivity standard is 95% per month. Additional duties may be assigned.

Requirements

Bachelor’s degree required.
Graduate of an accredited school of nursing.
Current RN licensure in the state of operation.
Three or more years of recent clinical experience.
If no nationally recognized certification is present at hire, obtain a URAC-recognized Case Management certification (ACM, CCM, CDMS, CMAC, CMC, CRC, CRRN, COHN, COHN-S, or RN-BC) within three years of hire.
Ability to make independent medical decisions and recommendations to all parties.
Effective multitasking skills in a high-volume, fast-paced, team-oriented environment.
Ability to interface with claims staff, attorneys and their representatives, physicians and their representatives, advisors/clients, and coworkers.
Excellent written and verbal communication skills.
Ability to meet designated deadlines.
Computer proficiency and technical aptitude, including ability to use MS Office and Excel spreadsheets.
Strong interpersonal, time-management, and organizational skills.
Ability to work independently and within a team environment.

Nice To Haves

Bachelor of Science in Nursing (BSN) preferred.
Clinical experience in rehabilitation preferred.
Strong clinical background in orthopedics, neurology, or rehabilitation preferred.
Strong cost-containment background, such as utilization review or managed care, helpful.
Certification as a CIRS or CCM preferred.

Responsibilities

Provide medical case management through coordination with the patient, physician, other health care providers, employer, and referral source.
Assess, plan, implement, and evaluate the patient's progress.
Evaluate treatment plans for appropriateness, medical necessity, and cost effectiveness.
Use medical and nursing knowledge to discuss current and alternate treatment plans with physicians.
Make medical recommendations about available treatment plans to the payer.
Implement care arrangements, including negotiating and coordinating delivery of durable medical equipment and nursing services.
Devise cost-effective strategies for medical care.
Prepare organized reports within specified timeframes.
Meet the minimum productivity standard of 95% per month.
Perform additional duties as assigned.