Telephonic Case Manager

Company: CorVel Corporation
Location: Nottingham
Posted on: January 15, 2021

Job Description:

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 RESPONSIBILITIES:

• 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 patient's progress.
• 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 timeframe.
• 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 (IIPP).
• Additional duties as required. ESSENTIAL FUNCTIONS AND RESPONSIBILITIES:
• 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.
• Workers Compensation experience highly preferable EDUCATION/EXPERIENCE:
• 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 in rehabilitation.
• --- CCM required to be obtained within 3 years of hire, if no nationally recognized accreditation 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.

Keywords: CorVel Corporation, Baltimore , Telephonic Case Manager, Executive , Nottingham, Maryland