Telephonic Case Manager I

CorVel Career Site•Tampa, FL

3d•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. Using clinical expertise, the Case Manager assesses whether current treatment plans are appropriate for each patient’s medical and physical condition and communicates directly with treating physicians to evaluate and recommend alternative care options when needed. The Case Manager also explains medical conditions and treatment plans to patients, family members, and adjusters, while supporting the objectives of the Case Management department and CorVel. This is a remote role. The position requires a Bachelor’s degree and graduation from an accredited school of nursing, along with current RN licensure in the state of operation. At least three years of recent clinical experience is required; rehabilitation experience is preferred. A URAC-recognized Case Management certification is required to be obtained within three years of hire if the employee does not have a nationally recognized certification at the time of hire. The pay range is $63,739–$95,264. Pay may vary based on location, skills, experience, qualifications, internal equity, and market conditions. CorVel offers a comprehensive benefits package to full-time regular employees. The company describes itself as a national provider of risk management solutions, founded in 1987, publicly traded since 1991, and employing over 4,000 people across the United States.

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.
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.
Certification as a CIRS or CCM preferred.

Responsibilities

Provide medical case management through coordination among 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 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.
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.