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.
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