Telephonic Case Manager I
2 weeks ago
CorVel Healthcare Corporation is seeking a skilled Telephonic Case Manager to join our team. As a Telephonic Case Manager, you will be responsible for coordinating resources and creating flexible, cost-effective options for ill or injured individuals on a case-by-case basis to facilitate quality individualized treatment goals, including timely return-to-work if appropriate.
The ideal candidate will have a strong clinical background in orthopedics, neurology, or rehabilitation, and possess a strong cost containment background, such as utilization review or managed care. A bachelor's degree in nursing or a related field is required, and a nationally recognized Case Management certification (ACM, CCM, CDMS, CMAC, CMC, CRC, CRRN, COHN, COHN-S, RN-BC) is preferred.
Key Responsibilities:
- Provides 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
- Ability to utilize their medical and nursing knowledge to allow the case manager to discuss the current treatment plan with the physician and discuss alternate treatment plans
- Ability to 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
- Ability to make independent medical decisions and recommendations to all parties
- Devise cost-effective strategies for medical care
- Required to read extensively
- Required to prepare organized reports within a specified timeframe
- Required to use telephone extensively
- Minimum Productivity Standard is 95% per month
- Requires regular and consistent attendance
- Complies with all safety rules and regulations during work hours in conjunction with the Injury and Illness Prevention Program (IIPP)
- Additional duties as required
Requirements:
- Bachelor's degree in nursing or a related field
- 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
Benefits:
- Comprehensive benefits package including Medical (HDHP) w/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, ROTH 401K, and paid time off
- Equal Opportunity Employer, drug free workplace, and complies with ADA regulations as applicable
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