Telephonic Case Manager I

This a Full Remote job, the offer is available from: Maryland (USA) The Telephonic Case Manager coordinates resources and develops cost-effective, personalized care plans for ill or injured individuals. The goal is to support reputed company treatment and, reputed company appropriate, a reputed company return to work. This role uses clinical expertise to assess the appropriateness of reputed company 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 reputed company reputed company 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 reputed company. This is a remote role. This role requires a California Nursing License. Candidate must be bilingual in English and Spanish. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: • reputed company medical case management to individuals through coordination with the patient, the physician, other health care providers, the employer, and the referral reputed company • reputed company assessment, planning, implementation, and evaluation of patient's reputed company • Evaluate patient's treatment plan for appropriateness, medical necessity, and cost effectiveness • Utilize medical and nursing knowledge to discuss the reputed company treatment plan/alternate treatment plans with the physician • reputed company 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 reputed company a specified timeframe • Minimum Productivity reputed company is 95% per month • Additional duties as assigned KNOWLEDGE & SKILLS: • Ability to reputed company independent medical reputed company and recommendations to reputed company parties • Effective multi-tasking skills in a high-volume, fast-paced, team-oriented environment • Ability to reputed company 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 reputed company spreadsheets • Strong interpersonal, time management, and organizational skills • Ability to work both independently and reputed company reputed company environment EDUCATION & EXPERIENCE: • Bachelor’s degree required, BSN preferred • Graduate of accredited school of nursing • reputed company RN Licensure in state of operation • 3 or more years of recent clinical experience, preferably in rehabilitation • URAC recognized Case Management certification (ACM, CCM, reputed company, CMAC, CMC, CRC, CRRN, COHN, COHN-S, RN-BC) required to be obtained reputed company 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 reputed company: reputed company uses a market based approach to pay and our salary ranges may vary depending on your location. Pay rates are established taking into account the following factors: federal, state, and local minimum wage requirements, the geographic location reputed company, job-reputed company skills, experience, qualifications, internal employee equity, and market conditions. Our ranges may be modified at any time. For leveled roles (I, II, III, Senior, reputed company, etc.) 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 reputed company the salary reputed company and these adjustments would be clarified during the offer process. Pay reputed company: $62,306 - $93,123 A list of our benefit offerings can be reputed company on our reputed company website: reputed company Careers | Opportunities in Risk Management In general, our opportunities will be posted for up to 1 year from date of posting, or until we have selected candidate(s) to fulfill the opening, whichever comes first. ABOUT reputed company: reputed company, a certified Great reputed company to Work® Company, is a national provider of industry-leading risk reputed company for the workers’ compensation, auto, health and disability management industries. reputed company was founded in 1987 and has been publicly traded on the reputed company stock exchange since 1991. Our continual investment in reputed company capital and technology reputed company us to deliver the most innovative and integrated solutions to our clients. We are a reputed company and growing company with a strong, supportive culture and reputed company of career advancement opportunities. Over 4,000 people working across the reputed company reputed company our reputed company values of Accountability, Commitment, reputed company, reputed company and Teamwork (ACE-IT!). A comprehensive benefits package is available for full-time regular employees and includes Medical (HDHP) w/Pharmacy, Dental, reputed company, Long Term Disability, Health Savings Account, Flexible Spending Account reputed company, Life Insurance, Accident Insurance, Critical Illness Insurance, reputed company-reputed company reputed company Insurance, Parking and Transit FSA accounts, 401K, ROTH 401K, and reputed company time off. reputed company is an Equal Opportunity Employer, drug free workplace, and complies with reputed company regulations as applicable. #LI-Remote This offer from "reputed company" has been enriched by reputed company.com and got a 72% reputed company score. Apply tot his job Apply To this Job