RN - Medical Allocator I

CorVel; Davenport (IA); Remote; USD 51,000 - 84,000; Full time

Job summary

Join a forward-thinking company as a Medicare Set-Aside Consultant, where you will leverage your medical expertise to develop reports for future Medicare-covered expenses. This role requires strong analytical skills and the ability to work independently while collaborating with various stakeholders. Enjoy the flexibility of remote work and be part of a supportive culture that values accountability and teamwork. With a focus on career advancement and a comprehensive benefits package, this is an exciting opportunity for those looking to make a meaningful impact in risk management solutions.

Benefits

Medical (HDHP) w/Pharmacy

Dental

Vision

Long Term Disability

Health Savings Account

401K

Paid time off

Qualifications

• Graduate of an accredited nursing school with current RN Licensure required.
• 3+ years clinical experience, preferably in rehabilitation.

Responsibilities

• Organize and assess medical records for Medicare-covered expenses.
• Collaborate with legal counsel to obtain necessary releases.

Skills

Effective multi-tasking

Written and verbal communication

Computer proficiency (MS Office)

Interpersonal skills

Time management

Organizational skills

Education

Graduate of accredited nursing school

Current RN Licensure

3+ years clinical experience

Certification as MSCC, CLCP, or CNLCP

Tools

MS Office (Excel)

Job description

The Medicare Set-Aside Consultant develops reports based upon guidelines provided by the Centers for Medicare and Medicaid Services outlining the future Medicare-covered expenses of individuals whose workers’ compensation or other liability claims are in the settlement process. The Medicare Set-Aside Consultant will rely on their medical knowledge to evaluate the patient’s treatment plan for future medical treatment needs supporting the goals of the Medicare Services department, and of CorVel. Work from home possible.

ESSENTIAL FUNCTIONS & RESPONSIBILITIES:

• Organize medical records into chronological order.
• Assess, review and summarize medical records in a clear, concise manner.
• Perform evidenced-based medical research regarding unfamiliar diagnoses and future medical needs.
• Ability to utilize medical and nursing knowledge to compile a comprehensive list of necessary future Medicare-covered expenses.
• Assign CPT coding and pricing to all future Medicare-covered expenses.
• Assign NDC coding and AWP pricing to all future medication pricing.
• Clarify need for Rated Age and obtain or calculate life expectancy.
• Calculate lifetime pricing utilizing state fee schedule or “usual & customary” charges.
• Collaborate with defense and plaintiff counsel in effort to obtain necessary signed releases from claimants.
• Verify claimant’s current Social Security Disability and Medicare eligibility.
• Prepare submission of MSA proposal to CMS for review and approval.
• Secure, analyze and dispute Medicare conditional payments unrelated to claims in the settlement process.
• Required to read extensively.
• Required to prepare organized reports within a specified timeframe.
• Required to use the telephone extensively.
• Minimum Productivity Standard is 95%.
• Requires regular and consistent attendance.
• Complies with all safety rules and regulations during work hours in conjunction with the Injury and Illness Prevention Program (IIPP).
• Additional duties as required.

KNOWLEDGE & SKILLS:

• Effective multi-tasking skills in a high-volume, fast-paced, team-oriented environment.
• Ability to interface with claims staff, attorneys, physicians and their representatives, and advisors/clients and coworkers.
• Excellent written and verbal communication skills.
• Ability to meet designated deadlines.
• Computer proficiency and technical aptitude with the ability to utilize MS Office including Excel spreadsheets.
• Strong interpersonal, time management and organizational skills.
• Ability to work both independently and within a team environment.

EDUCATION & EXPERIENCE:

• Graduate of an accredited school of nursing, BSN desirable.
• Current RN Licensure in the state of operation.
• 3 or more years of recent clinical experience, preferably in rehabilitation.
• Certification as a MSCC, CLCP, or CNLCP preferred.
• ICHCC approved course in Medicare Set-Aside completion within 3 months of hire date required.
• Successfully pass ICHCC Medicare Set-Aside Consultant examination within 4 months of hire date.
• Strong clinical background in orthopedics, neurology, or rehabilitation preferred.
• Strong cost containment background, such as utilization review or managed care helpful.

PAY RANGE:

CorVel uses a market-based approach to pay and our salary ranges may vary depending on your location. Pay rates are established taking into account the following factors: federal, state, and local minimum wage requirements, the geographic location differential, job-related skills, experience, qualifications, internal employee equity, and market conditions. Our ranges may be modified at any time.

For leveled roles (I, II, III, Senior, Lead, etc.) new hires may be slotted into a different level, either up or down, based on assessment during the interview process taking into consideration experience, qualifications, and overall fit for the role. The level may impact the salary range and these adjustments would be clarified during the offer process.

Pay Range: $51,807 – $83,551

A list of our benefit offerings can be found on our CorVel website: CorVel Careers | Opportunities in Risk Management

ABOUT CORVEL:

CorVel, a certified Great Place to Work Company, is a national provider of industry-leading risk management solutions for the workers’ compensation, auto, health and disability management industries. CorVel was founded in 1987 and has been publicly traded on the NASDAQ stock exchange since 1991. Our continual investment in human capital and technology enable us to deliver the most innovative and integrated solutions to our clients. We are a stable and growing company with a strong, supportive culture and plenty of career advancement opportunities. Over 4,000 people working across the United States embrace our core values of Accountability, Commitment, Excellence, Integrity and Teamwork (ACE-IT!).

A comprehensive benefits package is available for full-time regular employees and includes Medical (HDHP) w/Pharmacy, Dental, Vision, Long Term Disability, Health Savings Account, Flexible Spending Account Options, Life Insurance, Accident Insurance, Critical Illness Insurance, Pre-paid Legal Insurance, Parking and Transit FSA accounts, 401K, ROTH 401K, and paid time off.

CorVel is an Equal Opportunity Employer, drug-free workplace, and complies with ADA regulations as applicable.

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