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 TCM will rely on medical knowledge to evaluate the patient's current treatment plan. Must be able to discuss the patient's medical and physical conditions with the treating physicians. The TCM 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. This position will be remote in either Florida or Puerto Rico.
CorVel 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 3500 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.
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%.
- 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.
• Graduate of accredited school of nursing.
• Current RN licensure in state of operation.
• Case management experience in worker's compensation.
• Must have one of the following certifications: CCM, CRRN, CDMS, or COHN.
• 3 or more years' of recent clinical experience, preferably in rehabilitation.
• Strong clinical background in orthopedics, neurology, or rehabilitation preferred.
• Strong cost containment background, such as utilization review or managed care helpful.
CorVel is an Equal Opportunity Employer, drug free workplace, and complies with ADA regulations as applicable.