CA Utilization Review Case Manager I

CorVel; California; Remote; USD 43,000 - 63,000; Full time

Benefits offered by this job

Medical HDHP

Dental

Vision

Long-term disability

Health Savings Account

Paid time off

Job summary

CorVel is seeking a Utilization Review Case Manager to gather demographic and clinical information on patient admissions, certify medical necessity, and support the goals of the Case Management department. This remote position is ideal for experienced professionals in the nursing field.

Requirements include RN licensure in the state of operation and a BSN or associate degree, with 4+ years of clinical experience; OR/ICU/ER experience preferred.

Qualifications

• Graduate of accredited nursing school with an associate's degree, BSN, or BSN-equivalent.
• 4+ years of recent clinical experience required.
• Experience in OR, ICU, CCU, ER, and/or orthopedics preferred.

Responsibilities

• Identify the necessity of the review process and communicate issues to 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.

Skills

Utilization review

Nursing experience

Data collection

Documentation

Education

Associate degree in Nursing

Bachelor of Science in Nursing

Bachelor's degree in Nursing

Job description

About This Role

The Utilization Review Case Manager is responsible for gathering demographic and clinical information on patient admissions and treatment, certifying medical necessity, and supporting the goals of the Case Management department at CorVel. This remote position is ideal for experienced professionals in the nursing field.

Highlights

• Pay: $31 - $46/hour
• Location: Remote, CA
• Department/Unit: Case Management

What You'll Do

• Identify the necessity of the review process and communicate issues of concern to 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.
• 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 and publicly traded since 1991, CorVel invests in human capital and technology to deliver innovative solutions to clients. They offer a strong, supportive culture with ample career advancement opportunities.