Telephonic Case Manager I

1. About Our Client:

The organization operates in the risk management sector, providing solutions for workers' compensation, auto, health, and disability management industries. Founded in 1987 and publicly traded since 1991, the company addresses challenges in managing medical and disability claims by integrating technology and human capital to offer comprehensive and innovative services. With a workforce of over 4,000 across the United States, the program emphasizes a supportive culture focused on accountability, commitment, excellence, integrity, and teamwork.

2. About the Opportunity:

The Telephonic Case Manager I is responsible for coordinating resources and developing personalized, cost-effective care plans for individuals who are ill or injured. This role ensures quality treatment and supports timely return to work when appropriate. It involves assessing treatment plans using clinical expertise, communicating with physicians to evaluate and recommend care options, and explaining medical conditions and treatments to patients, families, and adjusters. The position contributes to the effectiveness of case management and overall care coordination.

3. Responsibilities:

• Manage medical case coordination with patients, physicians, healthcare providers, employers, and referral sources
• Assess, plan, implement, and evaluate patient progress
• Review treatment plans for appropriateness, medical necessity, and cost efficiency
• Discuss current and alternative treatment plans with physicians using clinical knowledge
• Provide medical recommendations to payers
• Coordinate delivery of durable medical equipment and nursing services
• Develop cost-effective medical care strategies
• Prepare organized reports within specified timeframes
• Maintain a minimum productivity standard of 95% monthly
• Perform additional duties as assigned

4. Requirements:

• Bachelor's degree required; BSN preferred
• Graduate of an accredited nursing school
• Current RN licensure in the operating state
• Minimum of 3 years of recent clinical experience, preferably in rehabilitation
• URAC recognized Case Management certification required within 3 years if not held at hire
• Strong clinical background in orthopedics, neurology, or rehabilitation preferred
• Experience in cost containment such as utilization review or managed care preferred
• Certification as CIRS or CCM preferred
• Ability to make independent medical decisions and recommendations
• Effective multi-tasking and communication skills in a fast-paced, team environment
• Proficiency with MS Office including Excel
• Strong interpersonal, time management, and organizational skills

5. Pay Range and Compensation Package:

• Pay Range: $63,739 - $95,264
• Pay is market-based and varies by location, experience, skills, and other factors
• Salary levels may be adjusted based on interview assessment of qualifications and fit

6. Benefits & Perks:

• Medical (HDHP) with pharmacy coverage
• Dental and vision insurance
• Long-term disability insurance
• Health Savings Account and Flexible Spending Account options
• Life, accident, critical illness, and pre-paid legal insurance
• Parking and transit flexible spending accounts
• 401K and ROTH 401K plans
• Paid time off

Equal Opportunity Statement:

Our client is an equal opportunity employer. They celebrate diversity and are committed to creating an inclusive environment for all employees. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, or national origin.

Note:

RemoteHunter is not the Employer of Record (EOR) for this role. Our purpose in this opportunity is to connect exceptional candidates with leading employers. We help job seekers worldwide discover roles that match their goals and guide them to complete their full application directly through the hiring company's career page or ATS.