UR Case Manager I

CorVel Corporation•Town of Salina, NY

8h•Remote

About The Position

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.

Requirements

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
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

Nice To Haves

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

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