Healthcare Case Management Specialist

2 weeks ago

Downers Grove, Illinois, United States CorVel Corporation Full time

The Telephonic Case Manager plays a pivotal role in orchestrating resources and devising adaptable, cost-efficient solutions for individuals facing health challenges, ensuring tailored treatment objectives are met, including facilitating timely return-to-work scenarios when applicable. Utilizing their medical expertise, the Telephonic Case Manager assesses the patient's ongoing treatment strategy for medical suitability based on their health status.

KEY RESPONSIBILITIES:

Deliver comprehensive medical case management by collaborating with the patient, healthcare providers, employers, and referral sources. Conduct thorough assessments, strategic planning, implementation, and evaluation of the patient's recovery progress. Review and appraise the patient's treatment plan for relevance, medical necessity, and financial viability. Leverage medical and nursing knowledge to engage in discussions regarding the current treatment plan with physicians and propose alternative strategies. Provide informed medical recommendations regarding available treatment options to payers. Coordinate care, including negotiating and arranging the provision of medical equipment and nursing services. Make independent medical decisions and recommendations to all stakeholders involved. Develop cost-effective healthcare strategies. Engage in extensive reading as part of ongoing professional development. Prepare organized reports within designated timeframes. Utilize telecommunication extensively in daily operations. Maintain a minimum productivity standard of 95% monthly. Ensure regular and consistent attendance. Adhere to all safety protocols and regulations during work hours in line with the Injury and Illness Prevention Program (IIPP). Undertake additional responsibilities as required.

REQUIRED SKILLS & COMPETENCIES:

Strong multi-tasking abilities in a dynamic, high-volume, team-oriented environment. Proficient in interfacing with claims personnel, legal representatives, healthcare providers, and clients. Exceptional written and verbal communication skills. Ability to meet established deadlines consistently. Proficient in computer applications, particularly MS Office, including Excel. Strong interpersonal, time management, and organizational capabilities. Capacity to work autonomously as well as collaboratively within a team setting.

EDUCATIONAL BACKGROUND:

A Bachelor's degree is mandatory; a BSN is preferred. Graduate from an accredited nursing program. Current RN Licensure in the relevant state. A minimum of three years of recent clinical experience, ideally in rehabilitation. URAC recognized Case Management certification (ACM, CCM, CDMS, CMAC, CMC, CRC, CRRN, COHN, COHN-S, RN-BC) is required to be obtained within three years of employment if no nationally recognized certification is held at the time of hiring. A solid clinical background in orthopedics, neurology, or rehabilitation is preferred. Experience in cost containment, such as utilization review or managed care, is advantageous. Certification as a CIRS or CCM is preferred.

COMPENSATION:

CorVel employs a market-based approach to compensation, and salary ranges may vary based on geographic location, job-related skills, experience, qualifications, internal equity, and market conditions. These ranges are subject to modification.

For roles at various levels (I, II, III, Senior, Lead, etc.), new hires may be assigned to a different level based on an assessment during the interview process, considering experience, qualifications, and overall fit for the position. The level may influence the salary range, and these adjustments will be clarified during the offer process.

Compensation Range: $63,902 – $96,662

A comprehensive benefits package is available for full-time regular employees, including 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, ROTH 401K, and paid time off. Additionally, Medical Case Managers are eligible for bonuses and will receive state-of-the-art technological devices to ensure ready access to CorVel's proprietary Case Management application, allowing staff to retrieve documents on the go and log activities as they occur.

CorVel is an Equal Opportunity Employer, maintains a drug-free workplace, and complies with ADA regulations as applicable.

#LI-Remote

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