CA UR Case Manager II

CorVel Career Site•Folsom, CA

5d•Remote

About The Position

The Utilization Review Case Manager gathers demographic and clinical information for prospective, concurrent, and retrospective inpatient admissions and outpatient treatment. The role certifies medical necessity and assigns an appropriate length of stay while supporting the goals of the Case Management department and CorVel. This is a remote position. The position requires thorough knowledge of CPT and ICD coding, the ability to communicate with claims staff, attorneys, physicians and their representatives, clients, advisors, and coworkers, and the ability to work independently and as part of a team in a high-volume, fast-paced environment. The role also requires effective organization, time management, written and verbal communication, interpersonal skills, and the ability to use Microsoft Office, including Excel spreadsheets.

Requirements

Thorough knowledge of CPT and ICD coding.
Ability to interface with claims staff, attorneys, physicians and their representatives, advisors, clients, and coworkers.
Effective organization skills in a high-volume, fast-paced environment.
Strong time management skills and ability to meet designated deadlines.
Excellent written and verbal communication skills.
Ability to work independently and within a team environment.
Strong interpersonal skills.
Ability to utilize Microsoft Office, including Excel spreadsheets.
Graduate of an 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; RN required unless local state regulations permit LVN/LPN.
Four or more years of recent clinical experience.

Nice To Haves

Knowledge of the workers’ compensation claims process.
Knowledge of outpatient utilization review.
Prospective, concurrent, and retrospective utilization review experience.
Clinical experience in OR, ICU, CCU, ER, and/or orthopedics.

Responsibilities

Identify the necessity of the review process and communicate concerns to appropriate claims staff or customers.
Collect and analyze data to make decisions regarding certification or denial of treatment.
Document all work appropriately.
Promote utilization review services with stakeholders.
Comply with safety rules and regulations during work hours in conjunction with the Injury and Illness Prevention Program (IIPP).
Perform additional duties as assigned.