Remote Utilization Review RN Case Manager II

Ultipro; Folsom (CA); Remote; USD 75,000 - 105,000; Full time

Benefits offered by this job

Medical benefits (HDHP)

Dental

Vision

401K

Job summary

CorVel is seeking a Utilization Review Case Manager to gather demographic and clinical data for inpatient and outpatient treatment, certify medical necessity, and assign appropriate length of stay.

This is a remote position supporting the CorVel Utilization Review/Case Management team; candidates should have CA RN licensure and 4+ years of clinical experience, including OR/ICU.

Strong knowledge of CPT/ICD coding, data analysis, and ability to work with claims staff and providers is essential.

Qualifications

• Graduate of accredited school of nursing with an associate’s degree, Bachelor of Science degree or Bachelor of Science in Nursing
• Current Nursing licensure in the state of operation required; 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 necessity of the review process and communicates issues to 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 during work hours (IIPP)
• Additional duties as assigned

Skills

CPT/ICD coding

Data analysis

Interfacing with stakeholders

Organization

Time management

Communication

Microsoft Office

Workers' compensation knowledge

Outpatient utilization review

Education

Nursing degree (ASN/BSN)

CA RN license

Tools

Microsoft Office (Excel)

Job description

CorVel is seeking a Utilization Review Case Manager to gather demographic and clinical data for inpatient and outpatient treatment, certify medical necessity, and assign appropriate length of stay.

This is a remote position supporting the CorVel Utilization Review/Case Management team; candidates should have CA RN licensure and 4+ years of clinical experience, including OR/ICU.

Strong knowledge of CPT/ICD coding, data analysis, and ability to work with claims staff and providers is essential.