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Medical Case Manager

Company: CorVel Corporation
Location: Fairfax
Posted on: January 15, 2021

Job Description:

JOB SUMMARY: The Medical Case Manager coordinates resources and creates flexible, cost-effective options for ill or injured individuals on a case-by-case basis to facilitate quality individualized treatment goals, including timely return-to-work if appropriate. 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
  • Heavy travel required; valid driver's license and good driving record with no traffic violations required.
  • 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).
  • Additional duties as required. 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
  • Strong interpersonal, time management and organizational skills.
  • Ability to work both independently and within a team environment. EDUCATION/EXPERIENCE:
  • Bachelor's degree required, BSN desirable.
  • Graduate of accredited school of nursing
  • Current RN Licensure in state of operation
  • Valid driver's license and good driving record with no traffic violations
  • 3 or more years' of recent clinical experience, preferably in rehabilitation.
  • URAC recognized Case Management certification (ACM, CCM, CDMS, CMAC, CMC, CRC, CRRN, COHN, COHN-S, RN-BC) required to be obtained within 3 years of hire if no nationally recognized certification is present at time of hire.
  • Strong clinical background in orthopedics, neurology, or rehabilitation preferred.
  • Strong cost containment background, such as utilization review or managed care helpful.
  • Certification as a CIRS or CCM preferred.

Keywords: CorVel Corporation, Washington DC , Medical Case Manager, Executive , Fairfax, DC

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