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 for a patient’s medical and physical condition and communicates directly with treating physicians to evaluate and recommend alternative care options when needed. The Case Manager explains medical conditions and treatment plans to patients, family members, and adjusters, while supporting the objectives of CorVel’s Case Management department. This is a remote role. The position provides medical case management by coordinating with patients, physicians, other healthcare providers, employers, and referral sources. It assesses and evaluates patient progress and treatment plans, makes medical recommendations to payers, and coordinates care including durable medical equipment and nursing services. The role also prepares organized reports within specified timeframes and is subject to a minimum monthly productivity standard of 95%.
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.
- URAC-recognized Case Management certification (ACM, CCM, CDMS, CMAC, CMC, CRC, CRRN, COHN, COHN-S, or RN-BC), or obtain one 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.
- Ability to multitask in a high-volume, fast-paced, team-oriented environment.
- Ability to interface with claims staff, attorneys and their representatives, physicians, advisors/clients, and coworkers.
- Excellent written and verbal communication skills.
- Ability to meet designated deadlines.
- Computer proficiency and technical aptitude, including use of Microsoft Office and Excel spreadsheets.
- Strong interpersonal, time management, and organizational skills.
- Ability to work independently and within a team.
Nice To Haves
- Bachelor of Science in Nursing (BSN).
- Recent clinical experience in rehabilitation.
- Strong clinical background in orthopedics, neurology, or rehabilitation.
- Cost containment background, such as utilization review or managed care.
- Certification as a CIRS or CCM.
Responsibilities
- Provide medical case management through coordination with the patient, physician, other healthcare 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, 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.
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) and Roth 401(k)
- Paid time off
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
