CA Telephonic Case Manager I

Ultipro; Folsom, Northern (CA, KY); On-site; USD 90,000 - 120,000; Full time

Benefits offered by this job

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

Paid time off

Job summary

CorVel is seeking a Telephonic Case Manager to coordinate resources and develop cost-effective, personalized care plans for ill or injured individuals. The role emphasizes clinical assessment, communication with physicians, and cost containment to support the CorVel Case Management department.

This is a remote position in the United States with responsibilities across multiple stakeholders, including patients, physicians, and payers.

Qualifications

• Must hold an accredited nursing degree and active RN licensure in the operation state.
• 3+ years of recent clinical experience, preferably in rehabilitation.
• URAC-recognized Case Management certification required within 3 years of hire if not already certified.

Responsibilities

• Coordinate medical case management across patient, physician, providers, employer, and referral source.
• Assess, plan, implement, and evaluate patient progress.
• Evaluate treatment plans for medical necessity and cost effectiveness.
• Discuss treatment plans with physicians and recommend alternatives as needed.
• Prepare organized reports within specified timeframes.
• Maintain productivity standards and comply with safety programs.

Skills

Clinical decision making

Multitasking

Interfacing with physicians

Communication skills

MS Office proficiency

Team collaboration

Independent work

Education

Bachelor's in Nursing or higher

RN Licensure (CA)

URAC/ CCM/ ACM certification (within 3 years)

Tools

EMR systems

Utilization review

Job description

The Telephonic Case Manager coordinates resources and develops cost-effective, personalized care plans for ill or injured individuals. The goal is to support quality treatment and, when appropriate, a timely return to work. This role uses clinical expertise to assess the appropriateness of current treatment plans based on the patient’s medical and physical condition. The Case Manager communicates directly with treating physicians to evaluate and recommend alternative care options when needed. They also explain medical conditions and treatment plans to patients, family members, and adjusters, while supporting the objectives of the Case Management department and of CorVel.

This is a remote position.

ESSENTIAL FUNCTIONS & RESPONSIBILITIES:

• Provide 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
• Utilize medical and nursing knowledge to discuss the current treatment plan/alternate treatment plans with the physician
• 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
• Devise cost-effective strategies for medical care
• Required to prepare organized reports within a specified timeframe
• Minimum Productivity Standard is 95% per month
• Complies with all safety rules and regulations during working hours in conjunction with the Injury and Illness Prevention Program (“IIPP”)
• Additional duties asassigned

KNOWLEDGE & SKILLS:

• Ability to make independent medical decisions and recommendations to all parties
• 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
• 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

PAY RANGE

CorVel uses a market based approach to pay and our salary ranges may vary depending on your location. Pay rates are established taking into account the following factors: federal, state, and local minimum wage requirements, the geographic location differential, job-related skills, experience, qualifications, internal employee equity, and market conditions. Our ranges may be modified at any time.

For leveled roles (I, II, III, Senior, Lead, etc.) new hires may be slotted into a different level, either up or down, based on assessment during interview process taking into consideration experience, qualifications, and overall fit for the role. The level may impact the salary range and these adjustments would be clarified during the offer process.

In general, our opportunities will be posted for up to 1 year from date of posting, or until we have selected candidate(s) to fulfill the opening, whichever comes first.

ABOUT CORVEL:

CorVel, a certified Great Place to Work® Company, is a national provider of industry-leading risk management solutions for the workers’ compensation, auto, health and disability management industries. CorVel was founded in 1987 and has been publicly traded on the NASDAQ stock exchange since 1991. Our continual investment in human capital and technology enable us to deliver the most innovative and integrated solutions to our clients. We are a stable and growing company with a strong, supportive culture and plenty of career advancement opportunities. Over 4,000 people working across the United States embrace our core values of Accountability, Commitment, Excellence, Integrity and Teamwork (ACE-IT!).

A comprehensive benefits package is available for full-time regular employees and includes 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.

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

Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws.For further information, please review the Know Your Rights notice from the Department of Labor.