CA Telephonic Case Manager II

Overview

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 remote position 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 Cor Vel.

• 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.
• Prepare organized reports within a specified timeframe.
• Meet Minimum Productivity Standard of 95% per month.
• Additional duties as assigned.

• 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.

• 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: $31.46 - $47.59 per hour. (

Note:

ranges may vary by location and may be adjusted during interview process.)

Cor Vel, a certified Great Place to Work® Company, is a national provider of industry-leading risk management solutions.

Cor Vel offers a comprehensive benefits package for full-time employees, including Medical (HDHP) with 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.

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