Remote CA RN Utilization Review - Case Manager II

CorVel; California; Remote; USD 44,000 - 68,000; Full time

Benefits offered by this job

Medical

Dental

Vision

401K

Job summary

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

Qualifications

• 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.

Responsibilities

• 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.

Skills

Clinical experience

Utilization review

Data analysis

Documentation

Education

Nursing degree required

Job description

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