Telephonic Case Manager I

This is a fully remote position, open to applicants in California.

📋 Description

• Deliver medical case management by collaborating with patients, healthcare providers, physicians, employers, and referral sources.

• Evaluate, plan, implement, and assess patient progress.

• Review treatment plans for their appropriateness, medical necessity, and cost-effectiveness.

• Leverage medical and nursing expertise to discuss current and alternative treatment options with physicians.

• Provide medical recommendations to the payer.

• Negotiate and coordinate the delivery of durable medical equipment and nursing services.

• Develop cost-effective strategies for medical care.

• Create structured reports within established timeframes.

• Maintain a minimum monthly productivity standard of 95%.

• Adhere to safety protocols and regulations under the Injury and Illness Prevention Program.

• Execute additional responsibilities as directed.

⛳️ Requirements

• A Bachelor’s degree is required; a BSN is preferred.

• Must be a graduate of an accredited nursing program.

• Current RN Licensure in the state of practice is necessary.

• A minimum of 3 years of recent clinical experience is required.

• URAC-recognized Case Management certification (such as ACM, CCM, CDMS, CMAC, CMC, CRC, CRRN, COHN, COHN-S, RN-BC) must be obtained within 3 years of hire if no nationally recognized certification is held at the time of hire.

• A strong clinical background in orthopedics, neurology, or rehabilitation is preferred.

• Background in cost containment, including utilization review or managed care, is advantageous.

• Certification as a CIRS or CCM is preferred.

• Ability to make independent medical decisions and recommendations is essential.

• Strong multi-tasking abilities in a high-volume, fast-paced, team-oriented environment.

• Capability to interact with claims staff, attorneys, physicians and their representatives, advisors/clients, and colleagues.

• Excellent written and verbal communication skills are required.

• Ability to meet specified deadlines is necessary.

• Proficiency in computer systems and technical skills, including MS Office and Excel spreadsheets, is necessary.

• Strong interpersonal, time management, and organizational skills are required.

• Must be able to work independently as well as collaboratively within a team environment.

🏝️ Benefits

• Medical (HDHP) with Pharmacy.

• Dental insurance.

• Vision insurance.

• 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.

• Opportunities for career advancement.

• Option for remote work.