CA Utilization Review Case Manager I

Job 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; supporting the goals of the Case Management department, and of CorVel.

Opportunity to work from home. Candidates must reside in Pacific Time Zone.

ESSENTIAL FUNCTIONS & RESPONSIBILITIES:

Identifies the necessity of the review process and communicates any specific issues of concern to the appropriate claims staff/customer

Collects data and analyzes information to make decisions regarding certification or denial of treatment Documenting all work in the appropriate manner

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:

Must have a thorough knowledge of both CPT and ICD coding

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

Ability to promote and market utilization review products with attorneys and claims staff

Strong ability to negotiate provider fees effectively

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

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 with a diploma/Associates degree (Bachelor of Science degree or Bachelor of Science in Nursing preferred)

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

Previous experience in the following areas, preferred:

Prospective, concurrent and retrospective utilization review

Experience in the clinical areas of O.R., I.C.U., C.C.U., E.R., orthopedics

Knowledge of the workers’ compensation claims process

Outpatient utilization review

PAY RANGE:

CorVel uses a market based approach to pay and our salary ranges may vary depending on your location. Pay rates are established taking into account the following factors: federal, state, and local minimum wage requirements, the geographic location differential, job-related skills, experience, qualifications, internal employee equity, and market conditions. Our ranges may be modified at any time.

For leveled roles (I, II, III, Senior, Lead, etc.) new hires may be slotted into a different level, either up or down, based on assessment during interview process taking into consideration experience, qualifications, and overall fit for the role. The level may impact the salary range and these adjustments would be clarified during the offer process.

Pay Range: $29.25 - $44.77 per hour

A list of our benefit offerings can be found on our CorVel website: CorVel Careers Opportunities in Risk Management

In general, our opportunities will be posted for up to 1 year from date of posting, or until we have selected candidate(s) to fulfill the opening, whichever comes first.

ABOUT CORVEL

CorVel, a certified Great Place to Work® Company, is a national provider of industry-leading risk management solutions for the workers’ compensation, auto, health and disability management industries. CorVel was founded in 1987 and has been publicly traded on the NASDAQ stock exchange since 1991. Our continual investment in human capital and technology enable us to deliver the most innovative and integrated solutions to our clients. We are a stable and growing company with a strong, supportive culture and plenty of career advancement opportunities. Over 4,000 people working across the United States embrace our core values of Accountability, Commitment, Excellence, Integrity and Teamwork (ACE-IT!).

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, and paid time off.

CorVel is an Equal Opportunity Employer, drug free workplace, and complies with ADA regulations as applicable.

#LI-Remote

Full-time

Fully remote