Remote Utilization Review Case Manager II

CorVel Corporation; Folsom (CA); Remoto; USD 90.000 - 120.000; Tempo pieno

Vantaggi offerti da questo lavoro

Medical package

Dental

Vision

401K

Paid time off

Descrizione del lavoro

CorVel Corporation, a national provider of risk management solutions, seeks a Utilization Review Case Manager. You will gather demographic and clinical data for in-patient admissions and outpatient treatment, certify medical necessity, and assign length of stay to support the Case Management department.

This remote role requires an RN license, 4+ years of clinical experience, UR knowledge, and strong CPT/ICD coding skills.

Competenze

• Graduate of accredited school of nursing with an associate’s degree, BSN or BS in Nursing.
• Current Nursing licensure in the state of operation required; RN preferred unless local regulations permit LVN/LPN.
• 4+ years of recent clinical experience; UR experience preferred.

Mansioni

• Identifies necessity of the review process and communicates issues to claims staff.
• Collects data and analyzes information to decide on certification or denial of treatment.
• Documents all work in the appropriate manner.
• Promotes utilization review services with stakeholders.
• Adheres to IIPP safety rules and regulations.

Conoscenze

CPT & ICD coding

Interfacing with claims staff

Organizational skills

Time management

Written & verbal communication

Teamwork

MS Office (including Excel)

Workers' compensation knowledge

Outpatient UR knowledge

Formazione

Associate or BSN nursing degree

Active RN license in state of operation

4+ years clinical experience

UR experience preferred

Strumenti

Microsoft Office

Excel

Descrizione del lavoro

CorVel Corporation, a national provider of risk management solutions, seeks a Utilization Review Case Manager. You will gather demographic and clinical data for in-patient admissions and outpatient treatment, certify medical necessity, and assign length of stay to support the Case Management department.

This remote role requires an RN license, 4+ years of clinical experience, UR knowledge, and strong CPT/ICD coding skills.