CA Utilization Review Case Manager I

CorVel Career Site•Folsom, CA

3d•Remote

About The Position

The Utilization Review Case Manager gathers demographic and clinical information on 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 role reviews and analyzes clinical information, documents work, communicates issues to claims staff and other stakeholders, and promotes utilization review services. The position requires current nursing licensure in the state of operation, with RN licensure required unless local regulations permit LVN/LPN. It also requires at least four years of recent clinical experience.

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 use 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 issues of concern to the appropriate claims staff or customer.
Collect data and analyze information to make decisions regarding certification or denial of treatment.
Document all work in the appropriate manner.
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.