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

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 case management plans and establishes case management goals. Provides assessment, planning, implementation and evaluation of patients progress.

Evaluates patients 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 attorneys 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 patients 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 drivers license and good driving record with no traffic violations required.

Maintains Billable Standard of 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.

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:

Graduate of accredited school of nursing, BSN

Current RN Licensure in state of operation

Valid drivers license and good driving record in compliance with CorVels policies

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

CCM required

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

CorVel Corporation is an Equal Opportunity Employer. In order to provide equal employment and advancement opportunities to all individuals, employment decisions at CorVel will be based on merit, qualifications and abilities. Except where required or permitted by law, employment practices will not be influenced or affected by an applicant's or employee's race, color, religion, sex, national origin, ancestry, citizenship, age, handicap or disability, marital status, medical condition or any other characteristic protected by applicable law.

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