Telephonic Case Manager II

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

📋 Description

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

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

• Assess treatment plans for relevance, medical necessity, and cost-effectiveness.

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

• Provide medical recommendations to payers.

• Negotiate and manage the provision of durable medical equipment and nursing services.

• Create cost-effective strategies for medical care.

• Compile organized reports within specified deadlines.

• Maintain a minimum monthly productivity standard of 95%.

• Adhere to safety protocols and regulations as outlined in the Injury and Illness Prevention Program.

• Undertake additional responsibilities as assigned.

⛳️ Requirements

• A Bachelor’s degree is required.

• Must be a graduate of an accredited nursing school.

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

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

• URAC recognized Case Management certification (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 exists at the time of hire.

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

• A strong background in cost containment, such as utilization review or managed care, is beneficial.

• Certification as a CIRS or CCM is preferred.

• Capability to make independent medical decisions and recommendations.

• Effective multi-tasking abilities in a high-volume, fast-paced, team-oriented setting.

• Proficiency in interfacing with claims staff, attorneys, physicians and their representatives, advisors/clients, and colleagues.

• Exceptional written and verbal communication skills.

• Ability to meet established deadlines.

• Proficient in computer and technical skills, including MS Office and Excel spreadsheets.

• Strong interpersonal, time management, and organizational abilities.

• Capability 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.