Remote RN Utilization Review Case Manager I

NurseRemotely; United States; Remote; USD 43,000 - 63,000; Full time

Benefits offered by this job

Medical w/ HDHP

Dental

Vision

Long Term Disability

Health Savings Account

Flexible Spending Account

Life Insurance

401K

ROTH 401K

Paid time off

Job summary

CorVel in the United States is seeking a Utilization Review Case Manager to gather demographic and clinical information, certify medical necessity, and assign appropriate length of stay for inpatient and outpatient treatment.

This remote role requires strong CPT/ICD coding knowledge, meticulous documentation, data analysis, and collaboration with claims staff, attorneys and providers to support the Case Management team.

Qualifications

• Nursing degree from an accredited school.
• RN licensure in the operation state required.
• 4+ years of clinical experience.
• Utilization review experience preferred.

Responsibilities

• Identify necessity of the review process and communicate concerns to claims staff.
• Collect data and analyze information to certify or deny treatment.
• Document all work in the appropriate manner.
• Promote utilization review services with stakeholders.
• Adhere to safety rules and regulations (IIPP).
• Perform additional duties as assigned.

Skills

CPT/ICD coding

Data analysis

Documentation

Interpersonal skills

Microsoft Office

Time management

Team collaboration

Education

Associate degree in Nursing

Bachelor of Science in Nursing

RN license

Tools

Microsoft Office

Job description

CorVel in the United States is seeking a Utilization Review Case Manager to gather demographic and clinical information, certify medical necessity, and assign appropriate length of stay for inpatient and outpatient treatment.

This remote role requires strong CPT/ICD coding knowledge, meticulous documentation, data analysis, and collaboration with claims staff, attorneys and providers to support the Case Management team.