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  • Santa Fe, NM

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Medical Case Manager II - Bilingual

Corvel • Santa Fe, NM

Posted 1 day ago

Job Snapshot

Full-Time
Experience - At least 3 year(s)
Degree - 2 Year Degree
Other Great Industries
Health Care, Management

Job Description

JOB SUMMARY:

Seeking BILINGUAL Medical Case Manager in the Albuquerque area. The service area for this position is the ENTIRE STATE OF NM. This will require regular travel. The Medical Case Manager coordinates resources and creates flexible, cost-effective options for ill or injured individuals This role may be worked remotely. Do you have experience in Orthopedics, Rehab/Neuro, ED, ICU, Occupational Health or Workers\u0027 Compensation? CorVel Corporation is the place for you. We are a rapidly growing managed care company working with Workers\u0027 Compensation clients.

This role will travel and manage a caseload of Workers Compensation cases for a Corvel office. Corvel is looking for self-motivated, energetic and independent nurses to fill case manager positions to be a part of our professional team.

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 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.
  • 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.
  • 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:

  • 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.
  • Strong cost containment background, such as utilization review or managed care helpful.
  • Certification as a CIRS or CCM 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\u0027s or employee\u0027s race, color, religion, sex, national origin, ancestry, citizenship, age, handicap or disability, marital status, medical condition or any other characteristic protected by applicable law.


Please be aware that CorVel generally does not review all applications submitted in response to job openings posted on the Internet because of the large volume of responses.

Note to Employment Agencies: Please do not forward agency resumes. CorVel Corporation is not responsible for any fees related to unsolicited resumes.

#cb *mon*

Job ID: MEDIC01632
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