CA UR Case Manager II

CorVel; California; A distancia; USD 44.000 - 68.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Medical

Dental

Vision

401K

Descripción de la vacante

CorVel is seeking a Remote CA UR Case Manager II to gather demographic and clinical information on admissions, certify medical necessity, and support Case Management goals in utilization review. This remote role suits experienced professionals aiming to impact patient care and payer processes in California.

The position requires nursing licensure, 4+ years of clinical experience, and proficiency in data collection, analysis, and documentation to support timely decisions and effective stakeholder

Formación

• 4+ years of recent clinical experience required.
• Prospective, concurrent, and retrospective utilization review experience preferred.
• Experience in OR, ICU, CCU, ER and/or orthopedics preferred.
• Current Nursing licensure in the state of operation; RN required unless local state regulations permit LVN/LPN.

Responsabilidades

• Identify necessity of the review process and communicate issues to claims staff/customer.
• Collect data and analyze information to decide on certification or denial of treatment.
• Document all work in the appropriate manner.
• Promote utilization review services with stakeholders.
• Comply with safety rules during work hours under IIPP.

Conocimientos

Clinical experience

Utilization review

Data analysis

Documentation

Educación

Nursing degree required

Descripción del empleo

About This Role

The CA UR Case Manager II is responsible for gathering demographic and clinical information on inpatient admissions and outpatient treatment, certifying medical necessity, and supporting the goals of the Case Management department at CorVel. This remote position is ideal for experienced professionals looking to make an impact in utilization review.

Highlights

• Pay: $32 - $49/hour
• Location: Remote, CA
• Department/Unit: Case Management
• Schedule: Full-time

What You'll Do

• Identify the necessity of the review process and communicate issues of concern to the appropriate claims staff/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 all safety rules and regulations during work hours in conjunction with the Injury and Illness Prevention Program (IIPP).
• Perform additional duties as assigned.

Requirements

Education:

• Graduate of accredited school of nursing with an associate's degree, Bachelor of Science degree, or Bachelor of Science in Nursing required.

Experience:

• 4 or more years of recent clinical experience required.
• Prospective, concurrent, and retrospective utilization review experience preferred.
• Experience in the clinical areas of OR, ICU, CCU, ER, and/or orthopedics preferred.

Licenses & Certifications:

• Current Nursing licensure in the state of operation required; RN is required unless local state regulations permit LVN/LPN.

Benefits

• 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 and ROTH 401K
• Paid time off

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. Founded in 1987, CorVel has been publicly traded on the NASDAQ stock exchange since 1991 and is committed to delivering innovative and integrated solutions to clients while fostering a strong, supportive culture.