Telephonic Case Management Specialist

2 weeks ago


Louisville, Kentucky, United States CorVel Corporation Full time

Position Overview:

The Telephonic Case Management Specialist plays a crucial role in coordinating healthcare resources and developing tailored, cost-efficient solutions for individuals facing health challenges. This position focuses on facilitating personalized treatment objectives, including timely return-to-work strategies when suitable. Utilizing their medical expertise, the specialist assesses the patient's existing treatment plan for medical validity based on their health status.

Key Responsibilities:

  • Deliver comprehensive medical case management by collaborating with patients, healthcare providers, employers, and referral sources.
  • Conduct thorough assessments, planning, implementation, and evaluation of patient progress.
  • Review and analyze the appropriateness, medical necessity, and cost-effectiveness of treatment plans.
  • Leverage medical and nursing knowledge to engage in discussions regarding current treatment strategies with physicians and propose alternative options.
  • Make informed medical recommendations regarding available treatment plans to payers.
  • Coordinate the provision of durable medical equipment and nursing services.
  • Exercise independent medical judgment and provide recommendations to all stakeholders.
  • Develop cost-effective medical care strategies.
  • Maintain extensive reading and prepare organized reports within designated timelines.
  • Utilize telecommunication extensively for case management.
  • Adhere to a minimum productivity standard of 95% and ensure consistent attendance.
  • Follow all safety protocols and regulations in accordance with the Injury and Illness Prevention Program (IIPP).
  • Perform additional duties as assigned.

Required Skills and Qualifications:

  • Strong multi-tasking abilities in a dynamic, high-volume environment.
  • Proficient in interacting with claims personnel, legal representatives, healthcare providers, and clients.
  • Exceptional written and verbal communication skills.
  • Ability to meet strict deadlines.
  • Proficient in computer applications, particularly MS Office, including Excel.
  • Excellent interpersonal, time management, and organizational skills.
  • Capability to work independently as well as collaboratively within a team.

Education and Experience:

  • Graduate from an accredited nursing program.
  • RN licensure required in multiple states.
  • Previous experience in case management, particularly in workers' compensation.
  • Certification in case management (CCM, CRRN, CDMS, or COHN) is mandatory.
  • A minimum of three years of recent clinical experience, ideally in rehabilitation.
  • Strong clinical background in orthopedics, neurology, or rehabilitation is preferred.
  • Experience in cost containment, such as utilization review or managed care, is advantageous.

Compensation and Benefits:

CorVel employs a market-based compensation strategy, and salary ranges may vary based on location and other factors. A comprehensive benefits package is available for full-time employees, including medical, dental, vision, and retirement plans, among others.

About CorVel:

CorVel Corporation is a leading provider of risk management solutions across various sectors, including workers' compensation and healthcare. Established in 1987, CorVel is recognized for its commitment to innovation and excellence in service delivery. The company fosters a supportive culture that encourages professional growth and development.

Equal Opportunity Employer: CorVel is an equal opportunity employer and maintains a drug-free workplace.



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