Medical Case Manager II
Company: CorVel Corporation
Posted on: January 15, 2021
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
- 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
- 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
- Performs or manages architectural assessment of patient's
- 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
- 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
- Additional duties as required. KNOWLEDGE & SKILLS:
- Effective multi-tasking skills in a high-volume, fast-paced,
- 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
- Strong interpersonal, time management and organizational
- Ability to work both independently and within a team
- 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
- 3 or more years' of recent clinical experience, preferably in
- 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
- Strong cost containment background, such as utilization review
or managed care helpful.
- Certification as a CIRS or CCM preferred.
Keywords: CorVel Corporation, Atlanta , Medical Case Manager II, Executive , Atlanta, Georgia
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