Remote RN Utilization Review Case Manager I

Socket.dev; Rancho Cucamonga (CA); On-site; USD 43,000 - 63,000; Full time

Benefits offered by this job

Medical (HDHP) w/Pharmacy

Dental

Vision

Long Term Disability

Health Savings Account

401K

Job summary

CorVel is seeking a Utilization Review Case Manager to collect demographic and clinical data for inpatient and outpatient treatment, certify medical necessity, and assign appropriate lengths of stay while supporting the Case Management department goals.

This is a remote position. You will interface with claims staff, physicians, and clients, perform data collection and decision-making, and ensure proper documentation of all work in a compliant manner.

Qualifications

• Must have nursing degree and active RN license.
• 4+ years of recent clinical experience.
• Prospective, concurrent, and retrospective utilization review experience preferred.
• Knowledge of CPT and ICD coding required.
• Experience in OR/ICU/ER/orthopedics preferred.

Responsibilities

• Identifies necessity of review process and communicates issues to claims staff.
• Collects data and analyzes information to certify or deny treatment.
• Documents all work in the appropriate manner.
• Promotes utilization review services with stakeholders.
• Complies with safety rules and IIPP in work hours.
• Additional duties as assigned.

Skills

CPT ICD coding

Data interface with claims/physicians

Time management

MS Office

Written and verbal communication

Team collaboration

Outpatient utilization review

Education

Nursing degree (RN)

Active RN license

Tools

Microsoft Office

Job description

CorVel is seeking a Utilization Review Case Manager to collect demographic and clinical data for inpatient and outpatient treatment, certify medical necessity, and assign appropriate lengths of stay while supporting the Case Management department goals.

This is a remote position. You will interface with claims staff, physicians, and clients, perform data collection and decision-making, and ensure proper documentation of all work in a compliant manner.