2022/08/31 Council Agenda Packet

SCHEDULE 2-A Care Advocacy Services Terms and Conditions 1. DESCRIPTION OF SERVICES (a) Care Advocate nurse service ("Care Advocate nurse") are provided immediately following the work injury to guide the claimant's injury recovery, up to 30 days following injury. The Care Advocate nurses oversee clinical assessment of the injury severity, validate/secure medical information, act as patient advocates and sets expectations for medical care and v. They identify the most appropriate treatment and/or most cost-effective health care alternatives. Care Advocate nurses may confer with the adjuster, attending physician, other medical providers, employer(s), attorney(s), the patient and the patient's family. 2. DELIVERY OF SERVICES (a) CorVel shall provide Care Advocate Services to Customer upon receipt by CorVel of specific requests from Customer, however unless otherwise agreed to by the parties, those cases that meet the Care Advocate referral criteria as mutually agreed shall be automatically referred to the Care Advocate Service. (b) Care Advocate nurse service: Care Advocate nurse service includes a four -point contact with claimant, employer, claims professional and provider. CorVel care advocates do the following: (i) facilitate communication among all appropriate parties regarding the diagnosis, prognosis and treatment plan provided by claimant's treating physician, (ii) channel or direct claimant to a PPO Network provider as appropriate, (iii) monitor and facilitate treatment planning, (iv) coordinate early return to work, and (v) subsequently provide periodic assessments of treatment and return to work plans up to 30 days following the work injury. Care Advocates may recommend additional services or coordinate claim closure, as appropriate. (c) Care Advocate nurses are responsible for completing detailed documentation within CareMC focusing on the claimant's medical condition, treatment plan and return to work status. Documentation includes but is not limited to primary injury diagnosis, comorbidities, treatment plan, medical goals, obstacles to recovery, work status and return to work. (d) Care Advocate nurses act nurse consultants to the claim team. (e) Care Advocate nurses act a patient advocates. (f) Care Advocate nurses assess appropriate medical follow-up, work closely with the claim team to identify potential barriers to recovery that may require further follow-up or additional services and develop medical action plans to ensure timely recovery and restoration of function. City of Everett, WA — CorVel EC Amendment 3 7-25-2022