Medical Case Manager

Corvel Rogers , AR 72757

Posted 1 month ago

The Medical Case Manager will rely on their medical knowledge to evaluate the patient's current treatment plan for medical appropriateness based on their physical and medical status. The Medical Case Manager must be able to discuss the patient's medical and physical conditions with the treating physicians, along with discussing/ recommending alternate treatment plans for the patient. The Medical Case Manager must have the ability to explain medical conditions and treatment plans to the patient, family members and adjuster; supporting the goals of the Case Management department, and of CorVel.

ESSENTIAL FUNCTIONS AND RESPONSIBILITIES:

  • Provides medical case management to individuals through communications with the patient, the physician, other health care providers, the employer and the referral source.

  • Makes recommendations regarding health care resources.

  • Develops Independent Medical Evaluation Plans. Provides assessment, planning, implementation and evaluation of patient's progress.

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

  • Implements care such as negotiation the delivery of durable medical equipment and nursing services. Devises cost-effective strategies for medical care.

  • Attends doctors, other providers, and attorney's visits. Attends 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. Initial home visit for initial evaluation.

  • Assesses rehabilitation facilities for appropriateness.

  • Utilizes their medical and nursing knowledge to discuss the current treatment plan with the physician and discuss alternate treatment plans.

  • Performs or manages architectural assessment of patient's home

  • Researches medical and community resources for medical and community resources for patients with catastrophic or chronic diagnoses, such as but not limited to, AIDS, cancer, spinal cord injury, diabetes, head injury, back injury, hand injury, burns, et cetera

  • Requires communicating with people outside the organization, representing the organization to customers, the public, government, and other external sources. This information can be exchanged in person, in writing, or by telephone or e-mail

  • Minimum Billable Standards are 1.8 to 2.2 hours per case, per week, working with an average of 18-24 FCE cases per month.

  • Requires regular and consistent attendance.

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

KNOWLEDGE & SKILLS:

  • Effective multi-tasking skills in a high-volume, fast-paced, team-oriented environment.

  • Ability to interface 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 Excel spreadsheets

  • Ability to drive, maneuver, navigate on a continual or almost continual basis

  • Heavy travel required; valid driver's license and good driving record with no traffic violations required.

EDUCATION/EXPERIENCE:

  • Graduate of accredited school of nursing, BSN desirable

  • Current RN Licensure in state of operation

  • Valid driver's license and good driving record in compliance with CorVel's policies

  • 3 or more years of recent clinical experience, preferably in rehabilitation.

  • CCM required to be obtained within 3 years of hire, if no nationally recognized accreditation is present at time of hire.

  • Strong clinical background in orthopedics, neurology, or rehabilitation preferred

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


icon no score

See how you match
to the job

Find your dream job anywhere
with the LiveCareer app.
Mobile App Icon
Download the
LiveCareer app and find
your dream job anywhere
App Store Icon Google Play Icon
lc_ad

Boost your job search productivity with our
free Chrome Extension!

lc_apply_tool GET EXTENSION

Similar Jobs

Want to see jobs matched to your resume? Upload One Now! Remove
Case Manager I Workers Compensation

Wal-Mart

Posted 2 months ago

VIEW JOBS 6/14/2019 12:00:00 AM 2019-09-12T00:00 Manages moderately complex workers' compensation claims by investigating facts of the case; determining compensability; evaluating medical records and physician recommendations; utilizing medical and legal resources; communicating with physicians to seek clarification or to question medical treatment; obtaining independent medical examinations; identifying preexisting injury or possibility of fraud; utilizing appropriate business writing techniques in reviewing, documenting, and indexing information and mail within the claim management system; reviewing potential settlements; determining probable exposure if any; and establishing appropriate reserves. Monitors associate disability management to ensure costs are appropriate by tracking serious injuries and recovery; analyzing exposure; compiling and reviewing documents and evidence; evaluating back-to-work issues; developing back-to-work action plans with physicians and store staff; negotiating with injured associates and legal or state board representatives; requesting medical records and billing documents; determining if payment is warranted to medical providers and/or injured associates; and ensuring payment is made. Manages monetary aspects of assigned claims by establishing appropriate reserves and authorizing payment or facilitating denial of the claim; engaging in negotiations with minimal supervision. Participates in moderately complex case reviews by reviewing files; summarizing facts; completing standardized forms; identifying legal issues; presenting claim information and possible exposure to senior management; offering recommendations to address issues, settlements, and reserve changes; and occasionally participating in depositions and arbitrations. Provides service to customers by sharing information; discussing resolution strategies with counsel; developing relationships with support areas; and providing guidance or suggestions to customers on alternate strategies, reserve assessment, and how to handle complex situations. Minimum Qualifications...Outlined below are the required minimum qualifications for this position. If none are listed, there are no minimum qualifications. Minimum Qualifications: Insurance Adjuster license OR will obtain an Insurance Adjuster license within 90 days of job entry date. Preferred Qualifications...Outlined below are the optional preferred qualifications for this position. If none are listed, there are no preferred qualifications. Customer Service, Insurance Bachelors: Arts, Bachelors: Science Minimum Qualifications Minimum Qualifications: Insurance Adjuster license OR will obtain an Insurance Adjuster license within 90 days of job entry date. About Walmart At Walmart, we help people save money so they can live better. This mission serves as the foundation for every decision we make, from responsible sourcing to sustainability—and everything in between. As a Walmart associate, you will play an integral role in shaping the future of retail, tech, merchandising, finance and hundreds of other industries—all while affecting the lives of millions of customers all over the world. Here, your work makes an impact every day. What are you waiting for? All the benefits you need for you and your family * Multiple health plan options * Vision & dental plans for you & dependents * Associate discounts in-store and online * Financial benefits including 401(k), stock purchase plans and more * Education assistance for Associate and dependents Frequently asked questions * On average, how long does it take to fill out an application? On average, it takes 45-60 minutes to complete your application for the first time. Subsequent applications will take less time to apply as our system saves some of your application information. Please note that some positions require the completion of assessments in order to receive consideration for that role. Those would take additional time. * Can I change my application after submitting? No, you cannot change your application after submitting, so please make sure that everything is finalized before you hit the submit button. * How do you protect my personal information? Processing of information on paper is minimal, and Walmart processes application information using an applicant tracking system (ATS). Access to the data within the ATS is restricted to authorized personnel, and the system itself is held to high security standards by Walmart. * What are the recommended Internet Browsers for applying for open roles? * Internet Explorer 8.0+ * Firefox 4.0+ * Safari 4.0+ * Chrome 12+ See All FAQs Recently viewed jobs Wal-Mart Rogers AR

Medical Case Manager

Corvel