Telephonic Case Manager
Company: CorVel Corporation
Posted on: January 15, 2021
JOB SUMMARY: 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. ESSENTIAL FUNCTIONS AND
- Provides medical case management to individuals through
coordination with the patient, the physician, other health care
providers, the employer, and the referral source.
- Assist in completing First Report of Injury/Illness form,
investigate claim, as appropriate, and processes completed First
Report forms per state regulations and customer guidelines.
- Coordinate Independent Medical Evaluations.
- Provide assessment, planning, implementation, and evaluation of
- 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
- Required to use telephone extensively.
- Minimum Productivity Standard is 95%.
- Maintains Billable Standard of .9 to 1.2 hours per case, per
week, working with an average of 45-
- 60 FCE cases per month.
- Requires regular and consistent attendance.
- Complies with all safety rules and regulations during work
hours in conjunction with the Injury and Illness Prevention Program
- Additional duties as required. ESSENTIAL FUNCTIONS AND
- Effective multi-tasking skills in a high-volume, fast-paced,
- 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
- Ability to work both independently and within a team
- Workers Compensation experience highly preferable
- Bachelor's degree required, BSN desirable.
- --- Graduate of accredited school of nursing
- --- Current RN Licensure in state of operation
- --- 3 or more years' of recent clinical experience, preferably
- --- CCM required to be obtained within 3 years of hire, if no
nationally recognized accreditation is present at time of
- --- Strong clinical background in orthopedics, neurology, or
- --- Strong cost containment background, such as utilization
review or managed care helpful.
- --- Certification as a CIRS or CCM preferred.
Keywords: CorVel Corporation, Baltimore , Telephonic Case Manager, Executive , Nottingham, Maryland
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