Role Description 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 role 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 of CorVel. This is a remote Telephonic Case Manager position for the Minnesota Certified Managed Care program. Candidates must have Minnesota RN license or be able to obtain within first 30 days. Essential Functions & Responsibilities:

• 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.
• Required to prepare organized reports within a specified timeframe.
• Minimum Productivity Standard is 95% per month.
• Additional duties as assigned.

Qualifications

• 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.
• Fluent Spanish language skills required (Read, Write, Speak).

Requirements

• 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.

Benefits

• Comprehensive benefits package available for full-time regular employees.
• 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.
• Paid time off.

Company Description

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!).