Remote RN Utilization Review Case Manager I

CorVel Brand; Rancho Cucamonga (CA); Remote; USD 85,000 - 125,000; Full time

Job summary

CorVel is seeking a remote Utilization Review Case Manager to assess in-patient admissions and outpatient treatment, certify medical necessity, and determine length of stay while supporting the Case Management department’s goals. This role requires RN licensure and 4+ years of clinical experience, with familiarity in CPT/ICD coding and utilization review processes.

The position emphasizes data collection, documentation, and collaboration with claims staff, attorneys, physicians, and clients to

Qualifications

• RN license required in state of operation.
• 4+ years of recent clinical experience.
• Prospective, concurrent, and retrospective utilization review experience preferred.
• Graduate of accredited school of nursing with an associate degree, BSN or BS in Nursing.

Responsibilities

• Gather demographic and clinical data for reviews.
• Certify medical necessity and assign appropriate length of stay.
• Document all work in the appropriate manner.
• Promote utilization review services with stakeholders.
• Additional duties as assigned.

Skills

CPT/ICD coding

Data analysis

Communications

Time management

Teamwork

MS Office

Interpersonal skills

Education

RN license

RNASN/BSN degree

Tools

Microsoft Excel

Claims software

Job description

CorVel is seeking a remote Utilization Review Case Manager to assess in-patient admissions and outpatient treatment, certify medical necessity, and determine length of stay while supporting the Case Management department’s goals. This role requires RN licensure and 4+ years of clinical experience, with familiarity in CPT/ICD coding and utilization review processes.

The position emphasizes data collection, documentation, and collaboration with claims staff, attorneys, physicians, and clients to