Remote Utilization Review Case Manager II – RN

CorVel Career Site; Folsom (CA); Remote; USD 85,000 - 115,000; Full time

Benefits offered by this job

Medical benefits

401K

Paid time off

Job summary

CorVel is seeking a Utilization Review Case Manager for a remote position in California. The role involves gathering demographic and clinical data, certifying medical necessity, and assigning appropriate lengths of stay for in-patient and outpatient treatment.

Strong CPT/ICD coding knowledge and excellent communication are essential. Ideal candidates will have RN licensure, 4+ years of clinical experience, and familiarity with workers’ compensation and outpatient utilization review.

Qualifications

• RN with state licensure required; BSN/ASN preferred.
• Minimum 4 years of recent clinical experience.
• Prospective, concurrent, and retrospective utilization review experience preferred.

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 properly and in a timely manner.
• Promote utilization review services with stakeholders.
• Comply with safety rules and IIPP.

Skills

CPT coding

ICD coding

Interfacing with stakeholders

Time management

Communication skills

Team collaboration

Microsoft Office

Workers’ comp knowledge

Education

RN with BSN/ASN

Tools

Microsoft Office Suite

Job description

CorVel is seeking a Utilization Review Case Manager for a remote position in California. The role involves gathering demographic and clinical data, certifying medical necessity, and assigning appropriate lengths of stay for in-patient and outpatient treatment.

Strong CPT/ICD coding knowledge and excellent communication are essential. Ideal candidates will have RN licensure, 4+ years of clinical experience, and familiarity with workers’ compensation and outpatient utilization review.