Telephonic Case Manager I

About the role

This is a remote role. The Telephonic Case Manager coordinates resources and develops cost-effective, personalized care plans for ill or injured individuals to support quality treatment and, when appropriate, a timely return to work. Nurses in all states are encouraged to apply.

Responsibilities

• Provide medical case management to individuals through coordination with the patient, the physician, other health care providers, the employer, and the referral source.
• Provide assessment, planning, implementation, and evaluation of patient's progress.
• Evaluate patient's treatment plan for appropriateness, medical necessity, and cost effectiveness.
• Utilize medical and nursing knowledge to discuss the current treatment plan/alternate treatment plans with the physician.
• Make medical recommendations of available treatment plans to the payer.
• Implement care such as negotiating and coordinating the delivery of durable medical equipment and nursing services.
• Devise cost-effective strategies for medical care.
• Prepare organized reports within a specified timeframe.
• Maintain a minimum productivity standard of 95% per month.
• Perform additional duties as assigned.

Requirements

• Bachelor’s degree required, BSN preferred.
• Graduate of accredited school of nursing.
• Current RN Licensure in state of operation.
• 3 or more years of recent clinical experience, preferably in rehabilitation.
• URAC recognized Case Management certification (ACM, CCM, CDMS, CMAC, CMC, CRC, CRRN, COHN, COHN-S, RN-BC) required to be obtained within 3 years of hire if no nationally recognized certification is present at time of hire.
• 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.
• National certification is preferred (CCM, COHN, CRRN, CDMS); otherwise, must be willing to sit for the exam.

Skills

• Ability to make independent medical decisions and recommendations to all parties.
• Effective multi-tasking skills in a high-volume, fast-paced, team-oriented environment.
• Ability to interface with claims staff, attorneys, physicians and their representatives, and advisors/clients and coworkers.
• Excellent written and verbal communication skills.
• Ability to meet designated deadlines.
• Computer proficiency and technical aptitude with the ability to utilize MS Office including Excel spreadsheets.
• Strong interpersonal, time management, and organizational skills.
• Ability to work both independently and within a team environment.

Pay

Pay Range: $63,739 - $95,264. CorVel uses a market-based approach to pay, taking into account federal, state, and local minimum wage requirements, geographic location differential, job-related skills, experience, qualifications, internal employee equity, and market conditions. For leveled roles, new hires may be slotted into a different level based on experience, qualifications, and overall fit, which may impact the salary range.

Benefits

• Medical (HDHP) with Pharmacy
• Dental
• Vision
• Long Term Disability
• Health Savings Account
• Flexible Spending Account Options
• Life Insurance
• Accident Insurance
• Critical Illness Insurance
• Pre-paid Legal Insurance
• Parking and Transit FSA accounts
• 401K and ROTH 401K
• Paid time off

About CorVel

CorVel, a certified Great Place to Work® Company, is a national provider of industry-leading risk management solutions for the workers’ compensation, auto, health, and disability management industries. Founded in 1987 and publicly traded on the NASDAQ stock exchange since 1991, CorVel invests in human capital and technology to deliver innovative and integrated solutions. The company has a strong, supportive culture with over 4,000 employees across the United States embracing core values of Accountability, Commitment, Excellence, Integrity, and Teamwork (ACE-IT!).