Telephonic Case Manager I

CorVel Corporation; Charleston, Northern (WV, KY); Hybrid; USD 65,000 - 85,000; Full time

Benefits offered by this job

Medical (HDHP) with Pharmacy

Dental

Vision

401K

Paid time off

Job summary

CorVel Corporation is seeking a Telephonic Case Manager to coordinate resources and develop personalized care plans for patients in the United States. This role requires clinical expertise in evaluating treatment plans and involves communicating with healthcare providers. Candidates must have an RN licensure and at least three years of clinical experience. The position offers a comprehensive benefits package and is fully remote, providing flexibility and support for medical cases.

Qualifications

• Graduate of an accredited school of nursing.
• Current RN licensure in the state of operation.
• Three or more years of recent clinical experience, preferably in rehabilitation.
• URAC recognized case-management certification to be obtained within three years of hire if no certification present at time of hire.

Responsibilities

• Provide medical case management to individuals.
• Assess, plan, implement, and evaluate patient progress.
• Evaluate treatment plans for appropriateness and cost-effectiveness.
• Negotiate and coordinate delivery of medical equipment and services.

Skills

Effective multi-tasking

Excellent communication skills

Computer proficiency

Interpersonal skills

Organizational skills

Ability to make independent decisions

Education

Graduate of an accredited school of nursing

Current RN licensure

3+ years clinical experience

Tools

MS Office

Job description

The Telephonic Case Manager coordinates resources and develops cost‑effective, personalized care plans for ill or injured individuals. 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 role.

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 the patient's progress.
• Evaluate the patient's treatment plan for appropriateness, medical necessity, and cost effectiveness.
• Utilize medical and nursing knowledge to discuss the current treatment plan or 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.
• Prepare organized reports within a specified timeframe.
• Maintain a minimum productivity standard of 95% per month.
• Perform additional duties as assigned.

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 an accredited school of nursing.
• Current RN licensure in the state of operation.
• Three 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) to be obtained within three 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 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. Ranges may be modified at any time.

Benefits

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.