Telephonic Case Manager - Case Management
Company: CorVel
Location: Downers Grove
Posted on: May 17, 2023
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Job Description:
Telephonic Case ManagerThe 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 & 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
KNOWLEDGE & SKILLS:
* 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 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
* 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
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.
Keywords: CorVel, Downers Grove , Telephonic Case Manager - Case Management, Executive , Downers Grove, Illinois
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