[Hiring] Utilization Review Case Manager I - RN @CorVel Career Site

Role Description

The Utilization Review Case Manager gathers demographic and clinical information on prospective, concurrent and retrospective in-patient admissions and out-patient treatment, certifies the medical necessity and assigns an appropriate length of stay while supporting the goals of the Case Management department and of CorVel. This is a remote role.

Essential Functions & Responsibilities

• Identifies the necessity of the review process and communicates issues of concern to the appropriate claims staff/customer
• Collects data and analyzes information to make decisions regarding certification or denial of treatment
• Documents all work in the appropriate manner
• Promotes utilization review services with stakeholders
• Additional duties as assigned

Qualifications

• Must have thorough knowledge of both CPT and ICD coding
• Ability to interface with claims staff, attorneys, physicians and their representatives, as well as advisors/clients and coworkers
• Effective organization skills in a high-volume, fast-paced environment
• Strong time management skills with the ability to meet designated deadlines
• Excellent written and verbal communication skills
• Ability to work both independently and within a team environment
• Strong interpersonal skills
• Ability to utilize Microsoft Office including Excel spreadsheets
• Knowledge of the workers’ compensation claims process preferred
• Knowledge of outpatient utilization review preferred

Requirements

• Graduate of accredited school of nursing with an associate’s degree, Bachelor of Science degree or Bachelor of Science in Nursing
• Current Nursing licensure in the state of operation required; RN is required unless local state regulations permit LVN/LPN
• 4 or more years of recent clinical experience
• Prospective, concurrent, and retrospective utilization review experience preferred
• Experience in the clinical areas of OR, ICU, CCU, ER and/or orthopedics preferred

Benefits

• CorVel uses a market based approach to pay and our salary ranges may vary depending on your location.
• Pay Range: $63,739 - $95,264
• A comprehensive benefits package is available for full-time regular employees and includes:
  • Medical (HDHP) w/Pharmacy
  • Dental
  • Vision
  • Long Term Disability
  • Health Savings Account
  • Flexible Spending Account Options
  • Life Insurance
  • Accident Insurance
  • Critical Illness Insurance
  • Pre-paid Legal Insurance
  • Parking and Transit FSA accounts
  • 401K
  • ROTH 401K
  • Paid time off