Remote RN Utilization Review Case Manager I

CorVel Corporation; Rancho Cucamonga (CA); Remote; USD 85,000 - 120,000; Full time

Benefits offered by this job

Medical (HDHP w/ Pharmacy)

Dental

Vision

401K

Paid time off

Parking & Transit

Job summary

CorVel Corporation is seeking a Utilization Review Case Manager for a fully remote role in the United States. The position requires current nursing licensure and 4+ years of clinical experience with preferred exposure to utilization review.

Responsibilities include data collection, decision-making on certification/denial, and careful documentation. Strong communication and organizational skills are essential.

Qualifications

• Graduate of accredited nursing program with RN license.
• 4+ years of recent clinical experience.
• Utilization review experience preferred.
• Knowledge of OR/ICU/ER/orthopedics is a plus.

Responsibilities

• Identify necessity of the review process and communicate issues to claims staff.
• Collect data and analyze information to certify or deny treatment.
• Document all work accurately.
• Promote utilization review services with stakeholders.
• Comply with safety rules and IIPP requirements.
• Additional duties as assigned.

Skills

CPT/ICD coding

Stakeholder communication

Time management

Written/verbal communication

Team collaboration

MS Office (Excel)

Workers’ compensation knowledge

Outpatient utilization review

Education

Associate or BSN in Nursing

RN license (state of operation)

BSN preferred

Tools

MS Office

EMR/claims systems

Job description

CorVel Corporation is seeking a Utilization Review Case Manager for a fully remote role in the United States. The position requires current nursing licensure and 4+ years of clinical experience with preferred exposure to utilization review.

Responsibilities include data collection, decision-making on certification/denial, and careful documentation. Strong communication and organizational skills are essential.