Remote Utilization Review Case Manager I - RN

CorVel Career Site; United States; Remote; USD 64,000 - 95,000; Full time

Benefits offered by this job

Comprehensive benefits package

401K / Roth 401K

Medical, Dental, Vision insurance

Paid time off

Job summary

The Utilization Review Case Manager at CorVel works remotely in the United States, gathering demographic and clinical information for inpatient and outpatient cases, certifying medical necessity and determining length of stay. The role emphasizes data collection, analysis, and documentation while collaborating with claims staff and stakeholders.

Requirements include nursing licensure (RN) and 4+ years of clinical experience, with preferred familiarity in OR/ICU/CCU/ER and outpatient utilization

Responsibilities

• Identify the necessity of the review process and communicates issues of concern to the appropriate claims staff/customer
• Collects data and analyzes information to make decisions regarding certification or denial of treatment
• Documents all work in the appropriate manner
• Promotes utilization review services with stakeholders
• Additional duties as assigned

Job description

The Utilization Review Case Manager at CorVel works remotely in the United States, gathering demographic and clinical information for inpatient and outpatient cases, certifying medical necessity and determining length of stay. The role emphasizes data collection, analysis, and documentation while collaborating with claims staff and stakeholders.

Requirements include nursing licensure (RN) and 4+ years of clinical experience, with preferred familiarity in OR/ICU/CCU/ER and outpatient utilization