Remote RN Utilization Review Case Manager I

CorVel; California; Remote; USD 64,000 - 95,000; Full time

Benefits offered by this job

Medical HDHP

Dental

Vision

Long Term Disability

Health Savings Account

Flexible Spending Account

Life Insurance

Accident Insurance

Critical Illness Insurance

Pre-paid Legal Insurance

Parking/Transit FSA

401K & Roth 401K

Paid time off

Job summary

CorVel seeks a Utilization Review Case Manager I to gather demographic and clinical data on admissions, certify medical necessity, and assign appropriate lengths of stay. This remote role supports the Case Management department and is ideal for experienced nurses.

Requires a nursing degree and an active RN license, with 4+ years of clinical experience and utilization review exposure. OR/ICU/ER experience is a plus; pay range is listed with full-time remote work in CA.

Qualifications

• RN license active in the operating state; LVN/LPN permitted where allowed by state.
• 4+ years of recent clinical experience in healthcare settings.
• Prospective, concurrent, and retrospective utilization review experience preferred; OR/ICU/ER/orthopedics experience is a plus.

Responsibilities

• Identify necessity of the review process and flag issues to claims staff or customer.
• Collect data and analyze information to decide on certification or denial of treatment.
• Document all work accurately in required systems and files.
• Promote utilization review services with stakeholders and teams.
• Perform additional duties as assigned by the supervisor.

Skills

Clinical experience

Utilization review

Communication skills

Education

Nursing degree (ADN/BSN/BSN-RN)

Job description

CorVel seeks a Utilization Review Case Manager I to gather demographic and clinical data on admissions, certify medical necessity, and assign appropriate lengths of stay. This remote role supports the Case Management department and is ideal for experienced nurses.

Requires a nursing degree and an active RN license, with 4+ years of clinical experience and utilization review exposure. OR/ICU/ER experience is a plus; pay range is listed with full-time remote work in CA.