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, explains medical conditions and treatment plans to patients, family members, and adjusters while supporting the objectives of the Case Management department and CorVel. This is a remote role. This role requires a California nursing license.
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 the 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.
Knowledge & Skills
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.
Education & Experience
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.
Pay Range
Pay Range: $65,436 - $98,982. CorVel uses a market‑based approach to pay and our salary ranges may vary depending on your location. Pay rates are established taking into account federal, state, and local minimum wage requirements, the geographic location differential, job‑related skills, experience, qualifications, internal employee equity, and market conditions. Our ranges may be modified at any time. For leveled roles, new hires may be slotted into a different level, either up or down, based on assessment during interview process taking into consideration experience, qualifications, and overall fit for the role. The level may impact the salary range and these adjustments would be clarified during the offer process.
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. Founded in 1987 and publicly traded on the NASDAQ since 1991, CorVel invests in human capital and technology to deliver innovative and integrated solutions to clients. The company offers a comprehensive benefits package to full‑time employees, including medical, 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, 401(k), ROTH 401(k), and paid time off. CorVel is an Equal Opportunity Employer, drug‑free workplace, and complies with ADA regulations as applicable.
Equal Opportunity Employment
CorVel is an Equal Opportunity Employer, drug‑free workplace, and complies with ADA regulations as applicable.