CA Utilization Review Case Manager I

CorVel Corporation; Rancho Cucamonga (CA); Remote; USD 60,000 - 100,000; Full time

Job summary

An established industry player is seeking a Utilization Review Case Manager to enhance patient care through effective management of admissions and treatment reviews. This remote position requires a thorough understanding of medical coding and strong analytical skills to ensure the medical necessity of treatments. The role offers the opportunity to work in a dynamic environment, collaborating with healthcare professionals and clients while promoting utilization review products. Join a company that values accountability, commitment, and teamwork, and enjoy a comprehensive benefits package along with career advancement opportunities in a supportive culture.

Benefits

Medical (HDHP) w/Pharmacy

Dental

Vision

Long Term Disability

Health Savings Account

Flexible Spending Account Options

Life Insurance

Accident Insurance

Critical Illness Insurance

401K and ROTH 401K

Qualifications

• Graduate of accredited nursing school with RN or LVN/LPN licensure.
• 4+ years of clinical experience, especially in utilization review.

Responsibilities

• Gather demographic and clinical information for patient admissions.
• Analyze data to certify or deny treatment requests.

Skills

CPT and ICD coding

Multi-tasking

Negotiation skills

Written and verbal communication

Time management

Interpersonal skills

Computer proficiency (MS Office)

Education

Diploma/Associates degree in Nursing

Bachelor of Science in Nursing (preferred)

Tools

MS Office (Excel)

Job description

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; supporting the goals of the Case Management department, and of CorVel.

This is a remote position.

ESSENTIAL FUNCTIONS AND RESPONSIBILITIES:

• Identifies the necessity of the review process and communicates any specific issues of concern to the appropriate claims staff/customer.
• Collects data and analyzes information to make decisions regarding certification or denial of treatment. Documenting all work in the appropriate manner.
• Requires regular and consistent attendance.
• Complies with all safety rules and regulations during work hours in conjunction with the Injury and Illness Prevention Program (IIPP).
• Additional duties as required.

KNOWLEDGE & SKILLS:

• Must have a thorough knowledge of both CPT and ICD coding.
• Effective multi-tasking skills in a high-volume, fast-paced, team-oriented environment.
• Ability to interface with claims staff, attorneys, physicians and their representatives, and advisors/clients and coworkers.
• Ability to promote and market utilization review products with attorneys and claims staff.
• Strong ability to negotiate provider fees effectively.
• Excellent written and verbal communication skills.
• Ability to meet designated deadlines.
• Computer proficiency and technical aptitude with the ability to utilize MS Office including Excel spreadsheets.
• Strong interpersonal, time management and organizational skills.
• Ability to work both independently and within a team environment.

EDUCATION/EXPERIENCE:

• Graduate of accredited school of nursing with a diploma/Associates degree (Bachelor of Science degree or Bachelor of Science in Nursing preferred).
• 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.
• Previous experience in the following areas, preferred:
  • Prospective, concurrent and retrospective utilization review.
  • Experience in the clinical areas of O.R., I.C.U., C.C.U., E.R., orthopedics.
  • Knowledge of the workers’ compensation claims process.
  • Outpatient utilization review.

PAY RANGE:

CorVel uses a market based approach to pay and our salary ranges may vary depending on your location. Pay rates are established taking into account the following factors: federal, state, and local minimum wage requirements, the geographic location differential, job-related skills, experience, qualifications, internal employee equity, and market conditions. Our ranges may be modified at any time.

For leveled roles (I, II, III, Senior, Lead, etc.) new hires may be slotted into a different level, either up or down, based on assessment during interview process taking into consideration experience, qualifications, and overall fit for the role. The level may impact the salary range and these adjustments would be clarified during the offer process.

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. CorVel was founded in 1987 and has been publicly traded on the NASDAQ stock exchange since 1991. Our continual investment in human capital and technology enable us to deliver the most innovative and integrated solutions to our clients. We are a stable and growing company with a strong, supportive culture and plenty of career advancement opportunities. Over 4,000 people working across the United States embrace our core values of Accountability, Commitment, Excellence, Integrity and Teamwork (ACE-IT!).

A comprehensive benefits package is available for full-time regular employees and includes 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, ROTH 401K, and paid time off.

CorVel is an Equal Opportunity Employer, drug free workplace, and complies with ADA regulations as applicable.