Telephonic Case Manager I
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. Using clinical expertise, the Case Manager assesses whether current treatment plans are appropriate based on patients’ medical and physical conditions, 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 position includes medical case management, patient progress assessment and evaluation, treatment-plan review, care coordination, cost-effective strategy development, and preparation of organized reports within specified timeframes. The minimum productivity standard is 95% per month.
Requirements
- Bachelor’s degree required; graduate of an accredited school of nursing.
- Current RN licensure in the state of operation.
- At least 3 years of recent clinical experience.
- Obtain a URAC-recognized Case Management certification (ACM, CCM, CDMS, CMAC, CMC, CRC, CRRN, COHN, COHN-S, or RN-BC) within 3 years of hire if no nationally recognized certification is held at 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, 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 use of MS Office and Excel spreadsheets.
- Strong interpersonal, time management, and organizational skills.
- Ability to work independently and within a team environment.
Nice To Haves
- BSN preferred.
- Recent 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.
- CIRS or CCM certification preferred.
Responsibilities
- Coordinate medical case management with patients, physicians, other health care providers, employers, and referral sources.
- Assess, plan, implement, and evaluate patient progress.
- Evaluate treatment plans for appropriateness, medical necessity, and cost effectiveness.
- Use medical and nursing knowledge to discuss current and alternative treatment plans with physicians.
- Make medical recommendations about available treatment plans to the payer.
- Implement care, including negotiating and coordinating delivery of durable medical equipment and nursing services.
- Develop cost-effective strategies for medical care.
- Prepare organized reports within specified timeframes.
- Perform additional duties as assigned.
Benefits
- Medical (HDHP) with pharmacy coverage
- Dental insurance
- Vision insurance
- Long-term disability insurance
- Health Savings Account
- Flexible Spending Account options
- Life insurance
- Accident insurance
- Critical illness insurance
- Pre-paid legal insurance
- Parking and Transit FSA accounts
- 401(k)
- Roth 401(k)
- Paid time off
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
