Remote RN Utilization Review Case Manager I

CorVel Corporation; Rancho Cucamonga (CA); Remote; USD 64,000 - 95,000; Full time

Benefits offered by this job

Medical (HDHP) w/Pharmacy

Dental

Vision

401K

Paid time off

Job summary

CorVel Corporation is seeking a Utilization Review Case Manager for a remote role. The incumbent gathers demographic and clinical information for inpatient and outpatient treatment, certifies medical necessity, and assigns length of stay to support the Case Management department.

Essential duties include data collection and analysis for certification decisions, thorough documentation, and collaboration with claims staff and physicians.

Qualifications

• Graduate of accredited nursing program with an associate or BSN.
• Current RN licensure required; LVN/LPN permitted per state rules.
• 4+ years of recent clinical experience.
• Prospective, concurrent, and retrospective utilization review experience preferred.

Responsibilities

• Identify necessity of review process and communicate issues to claims staff.
• Collect data and analyze information to decide certification or denial of treatment.
• Document all work properly.
• Promote utilization review services with stakeholders.
• Perform additional duties as assigned.

Skills

CPT/ICD coding

communication skills

organizational skills

time management

written/verbal communication

teamwork ability

MS Office (Excel)

workers’ compensation knowledge

outpatient utilization review

Education

RN licensure (state of operation)

BSN/ASN or ADN

Tools

Microsoft Office (Excel)

Job description

CorVel Corporation is seeking a Utilization Review Case Manager for a remote role. The incumbent gathers demographic and clinical information for inpatient and outpatient treatment, certifies medical necessity, and assigns length of stay to support the Case Management department.

Essential duties include data collection and analysis for certification decisions, thorough documentation, and collaboration with claims staff and physicians.