CA Utilization Review Case Manager I

CorVel Corporation•Folsom, CA

4d•$31 - $46•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 position requires thorough knowledge of CPT and ICD coding, strong communication and organizational skills, and the ability to manage deadlines in a high-volume, fast-paced environment. The case manager interfaces with claims staff, attorneys, physicians and their representatives, clients, advisors, and coworkers, and works independently as well as with a team. Applicants must be graduates of an accredited nursing school with an associate’s degree, Bachelor of Science degree, or Bachelor of Science in Nursing; hold current nursing licensure in the state of operation; and have at least four years of recent clinical experience. An RN is required unless local regulations permit an LVN/LPN. The pay range is $30.64–$45.80 per hour. CorVel’s comprehensive benefits package for full-time regular employees includes medical coverage, dental and vision insurance, long-term disability, health and flexible spending accounts, life and other insurance options, pre-paid legal insurance, parking and transit FSA accounts, 401(k), Roth 401(k), and paid time off.

Requirements

Thorough knowledge of CPT and ICD coding.
Ability to interface with claims staff, attorneys, physicians and their representatives, advisors, clients, and coworkers.
Effective organizational 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.
At least 4 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 appropriate claims staff or customers.
Collect data and analyze information 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.