Telephonic Nurse Case Manager

CorVel Corporation in Dublin, OH

  • Type: Full Time
position filled
GENERAL DESCRIPTION
The Telephonic Case Manager performs initial and on-going clinical assessment and evaluation needed for treatment of work related injury and illness. The Telephonic Case Manager coordinates resources with on-going monitoring 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.

REQUIRED EDUCATION/TRAINING
Graduate of an accredited school of nursing with an Associates Degree (or higher).
Current State of Ohio RN licensure unrestricted.
Prefer two years of full-time direct clinical care to the consumer, preferably in rehabilitation, orthopedics, critical care or neurology/neurosurgery.

Previous experience involving judgment and decision making in a utilization or case management positions for two (2) years preferred.

Maintains one current URAC approved certifications as a case manager:

CCM, Certified Case Manager

CDMS, Certified Disability Management Specialist

CMAC, Case Management Administrator, Certified

CMC, Case Management Certified

CRC, Certified Rehabilitation Counselor

CRRN, Certified Registered Rehabilitation Nurse

COHN, Certified Occupational Health Nurse

RN,C Registered Nurse Case Manager

RN,BC Registered Nurse Case Manager



PREFERRED EDUCATION
Strong cost containment background, such as utilization review or managed care required.
Ohio workers compensation case management experience required.
BSN preferred.




ESSENTIAL JOB DUTIES

Obtains missing mandatory data elements and ensures subsequent EDI to BWC.

Provides and maintains medical case management to the injured worker through coordination with the patient, the physician, employer, other health care providers, and the referral source.

Performs the six essential activities of case management: Assessment, planning, implementation, coordination, monitoring and evaluation of work related injuries and illnesses.

Assess resource utilization and cost management, the diagnosis, treatment, prognosis, short and long term goals.

Develops and maintains current case management plans on assigned caseload.

Identify opportunities for intervention to return the injured worker to work at the earliest and safest opportunity.

Follows established policies and procedures.

Utilizes national treatment guidelines to support clinical decision making.

Provide assessment, planning, implementation, and evaluation of patient's progress.

Evaluate patient's treatment plan for appropriateness, medical necessity, and cost effectiveness.

Implement care such as negotiating and coordinating the delivery of durable medical equipment and nursing services.

Researches medical and community resources for injured workers with catastrophic or chronic diagnoses, such as but not limited to, spinal cord injury, head injury, back injury, hand injury, burns, et cetera.

Follows up on doctors visits.

Follows up hospital and/or long-term facility discharge planning conferences, et cetera for the purpose of determining appropriateness of care and developing an effective long-term care strategy.

Assesses rehabilitation facilities for appropriateness

Devise cost-effective strategies for medical care.

Works well in team environment, and educates non-clinical staff when opportunity presents.

Required to read extensively.

Required to prepare organized reports within a specified timeframe.

Required to use telephone extensively.

Minimum Quality Assurance score is 95%

Complies with HR policy regarding regular and consistent attendance.

Comply with all safety rules and regulations during work hours in conjunction with the Injury and Illness Prevention Program (IIPP).

Additional duties as required.

Application Instructions:

We are an Equal Opportunity Employer. All persons shall have the opportunity to be considered for employment without regard to their race, color, age, sex, gender, religion, national origin, ancestry, citizenship status, physical or mental disability, military service, veteran status or any other characteristic protected by applicable federal, state or local law.
We will endeavor to make a reasonable accommodation to the known physical or mental limitations of a qualified applicant with a disability unless the accommodation would impose an undue hardship on the operation of our business. If you believe you require such assistance to complete this application or to participate in an interview, please let us know.
Note to Employment Agencies: Please do not forward agency resumes. CorVel Corporation is not responsible for any fees related to unsolicited resumes.

Please be aware that CorVel generally does not review all applications/resumes submitted in response to job openings posted on the Internet because of the large volume of responses

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