Telephonic Case Manager I

CorVel Corporation; Orlando (FL); On-site; USD 64,000 - 95,000; Full time

Benefits offered by this job

Medical and Dental benefits

Vision insurance

401K retirement plan

Paid time off

Job summary

CorVel Corporation, a national risk management solutions provider, seeks a Telephonic Case Manager in Orlando, FL. You will coordinate care, assess treatment plans, and communicate with physicians, patients, and payers to optimize outcomes and costs. A licensed RN with clinical rehab experience is required.

You will work in a fast-paced team environment, using MS Office tools to document progress and outcomes, while ensuring timely, evidence-based decision making in care management.

Qualifications

• Bachelor’s degree required; BSN preferred.
• Current RN licensure in state of operation.
• 3+ years of recent clinical experience, preferably in rehabilitation.
• URAC recognized Case Management certification required within 3 years if none on hire.
• Strong clinical background in orthopedics, neurology, or rehabilitation preferred.

Responsibilities

• Provide medical case management through coordination with patient, physician, other providers, employer, and referral source.
• Assess, plan, implement, and evaluate patient progress.
• Evaluate treatment plan for appropriateness, necessity, and cost effectiveness.
• Discuss current/alternate plans with physician; make medical recommendations to payer.
• Coordinate durable medical equipment and nursing services; devise cost-effective strategies.
• Prepare organized reports within specified timeframes; maintain productivity standards.
• Other duties as assigned.

Skills

Independent medical decisions

Multi-tasking in high-volume setting

Interfacing with claims staff/physians

Written and verbal communication

Deadline-driven

MS Office proficiency

Interpersonal skills

Time management

Organizational skills

Team work / independent work

Education

Bachelor’s degree

RN licensure (state of operation)

Graduate of accredited school of nursing

URAC Case Management certification (or equivalent) within 3 years

3+ years of clinical experience (rehabilitation preferred)

Certification as CIRS or CCM preferred

Tools

MS Office

Excel

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.

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
• 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

• Bachelor’s degree required, BSN preferred
• 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.

Pay Range: $63,739 - $95,264

A list of our benefit offerings can be found on our CorVel website: CorVel Careers | Opportunities in Risk Management

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.