Remote RN Utilization Review Case Manager I

CorVel Brand; Folsom (CA); Remote; USD 75,000 - 105,000; Full time

Benefits offered by this job

Remote work option

Comprehensive benefits package

401K and Roth 401K

Paid time off

Job summary

CorVel is seeking a Utilization Review Case Manager to gather demographic and clinical data for in-patient and outpatient reviews, certify medical necessity, and assign appropriate LOS while supporting the Case Management department’s goals. This remote role requires RN licensure and 4+ years of clinical experience.

The position emphasizes collaboration with claims staff, physicians, and clients, strong documentation, and knowledge of CPT/ICD coding in a fast-paced environment.

Qualifications

• RN licensure in the state of operation is required
• 4+ years of recent clinical experience
• Prospective, concurrent, and retrospective utilization review experience preferred
• Graduate of an accredited school of nursing (ADN/BSN)

Responsibilities

• Identifies necessity of the review process and communicates issues to claims staff/customer
• Collects data and analyzes information to make certification decisions
• Documents all work
• Promotes utilization review services with stakeholders
• Adheres to safety rules and regulations (IIPP)

Skills

CPT coding

ICD coding

Interpersonal skills

Time management

Communication

Teamwork

Microsoft Excel

Workers’ compensation knowledge

Education

Associate's degree in Nursing

Bachelor of Science in Nursing

RN licensure

Tools

Microsoft Excel

Microsoft Word

Job description

CorVel is seeking a Utilization Review Case Manager to gather demographic and clinical data for in-patient and outpatient reviews, certify medical necessity, and assign appropriate LOS while supporting the Case Management department’s goals. This remote role requires RN licensure and 4+ years of clinical experience.

The position emphasizes collaboration with claims staff, physicians, and clients, strong documentation, and knowledge of CPT/ICD coding in a fast-paced environment.