Telephonic Case Manager II
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Job Description
Telephonic Case Manager coordinating personalized medical care plans for CorVel’s workers’ compensation and disability management clients. Assessing treatment, recommending alternatives, and coordinating services remotely.
Responsibilities:
- Provide medical case management through coordination with patients, physicians, healthcare 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 to payers
- Negotiate and coordinate delivery of durable medical equipment and nursing services
- Devise cost-effective medical care strategies
- Prepare organized reports within specified timeframes
- Maintain a minimum productivity standard of 95% per month
- Comply with safety rules and regulations under the Injury and Illness Prevention Program
- Perform additional duties as assigned
Requirements:
- Bachelor’s degree required
- Graduate of accredited school of nursing
- Current RN Licensure in state of operation
- 3 or more years of recent clinical experience
- 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
- Ability to make independent medical decisions and recommendations
- Effective multi-tasking 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 MS Office and Excel spreadsheets
- Strong interpersonal, time management, and organizational skills
- Ability to work independently and within a team environment
Benefits:
- Medical (HDHP) with Pharmacy
- Dental insurance
- Vision insurance
- 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
- ROTH 401K
- Paid time off
- Career advancement opportunities
- Remote work
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