Remote Utilization Review Case Manager – RN

Ultipro; Rancho Cucamonga (CA); Remote; USD 85,000 - 110,000; Full time

Job summary

CorVel seeks an experienced Utilization Review Case Manager to gather demographic and clinical information for inpatient and outpatient treatments, certify medical necessity, and assign length of stay to support the Case Management department.

This remote position requires RN licensure and strong knowledge of CPT/ICD coding, with 4+ years of clinical experience and UR expertise. Collaboration with claims staff, physicians, and clients is essential.

Qualifications

• Graduate of an accredited school of nursing with an associate’s degree or BSN.
• Current Nursing license in the state of operation; RN is required unless local state regulations permit LVN/LPN.
• 4 or more years of recent clinical experience.
• Prospective, concurrent, and retrospective utilization review experience preferred.
• Experience in OR, ICU, CCU, ER and/or orthopedics preferred.

Responsibilities

• Identifies 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.
• Complies with safety rules and regulations during work hours in conjunction with IIPP.
• Additional duties as assigned.

Skills

CPT coding

ICD coding

Interpersonal skills

Time management

Communication

Teamwork

MS Office

Excel

Workers' comp knowledge

Outpatient utilization review

Education

RN license

Nursing degree (ADN/BSN)

Job description

CorVel seeks an experienced Utilization Review Case Manager to gather demographic and clinical information for inpatient and outpatient treatments, certify medical necessity, and assign length of stay to support the Case Management department.

This remote position requires RN licensure and strong knowledge of CPT/ICD coding, with 4+ years of clinical experience and UR expertise. Collaboration with claims staff, physicians, and clients is essential.