Remote Utilization Review Nurse Case Manager I

CorVel Corporation; Rancho Cucamonga (CA); Remote; USD 65,000 - 90,000; Full time

Benefits offered by this job

Comprehensive benefits package

Job summary

CorVel Corporation is seeking a Utilization Review Case Manager for a remote role. The candidate will collect and analyze clinical data to certify medical necessity and determine length of stay for inpatient and outpatient treatment.

The position requires a Nursing license (RN) with 4+ years of clinical experience. CPT/ICD coding knowledge and strong communication skills are essential.

Qualifications

• Graduate with RN licensure in the state of operation.
• 4+ years of recent clinical experience required.
• Experience in utilization review preferred.
• Knowledge of CPT and ICD coding essential.

Responsibilities

• Identify necessity of the review process and inform claims staff.
• Collect and analyze data to support certification or denial decisions.
• Document all work in required systems.
• Promote utilization review services with stakeholders.
• Perform additional duties as assigned.

Skills

CPT & ICD coding

Interfacing with claims staff

Time management

Written and verbal communication

Microsoft Office (Excel)

Independence and teamwork

Workers’ compensation knowledge (pref)

Outpatient utilization review (pref)

Education

Bachelor of Science in Nursing

Associate degree in Nursing

Tools

Microsoft Office

Job description

CorVel Corporation is seeking a Utilization Review Case Manager for a remote role. The candidate will collect and analyze clinical data to certify medical necessity and determine length of stay for inpatient and outpatient treatment.

The position requires a Nursing license (RN) with 4+ years of clinical experience. CPT/ICD coding knowledge and strong communication skills are essential.