Telephonic Case Manager I

The Telephonic Case Manager coordinates resources and creates 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 Telephonic Case Manager will rely on their medical knowledge to evaluate the patient’s current treatment plan for medical appropriateness based on their physical and medical status. The Telephonic Case Manager must be able to discuss the patient’s medical and physical conditions with the treating physicians, along with discussing/ recommending alternate treatment plans for the patient. The Telephonic Case Manager must have the ability to explain medical conditions and treatment plans to the patient, family members and adjuster; supporting the goals of the Case Management department, and of CorVel.

Candidate can live in a compact nursing license state, but would need to secure an IL upon hire. Will consider candidates in non-compact state, but candidate would need to secure additional licenses upon hire.

ESSENTIAL FUNCTIONS AND 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%.
• 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.

KNOWLEDGE & SKILLS:

• 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.

EDUCATION & EXPERIENCE:

• Graduate of accredited school of nursing.
• RN license required in IL, IN, KY and PA
• Additional RN licenses beneficial, but not required.
• Case management experience in worker’s compensation.
• Must have one of the following certifications: CCM, CRRN, CDMS, or COHN.
• 3 or more years’ of recent clinical experience, preferably in rehabilitation.
• Strong clinical background in orthopedics, neurology, or rehabilitation preferred.
• Strong cost containment background, such as utilization review or managed care helpful.