Remote RN Utilization Review Case Manager (California)

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

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.