Utilization Review Case Manager I

CorVel; California; Remote; USD 64,000 - 95,000; Full time

Benefits offered by this job

Medical HDHP

Dental

Vision

Long Term Disability

Health Savings Account

Flexible Spending Account

Life Insurance

Accident Insurance

Critical Illness Insurance

Pre-paid Legal Insurance

Parking/Transit FSA

401K & Roth 401K

Paid time off

Job summary

CorVel seeks a Utilization Review Case Manager I to gather demographic and clinical data on admissions, certify medical necessity, and assign appropriate lengths of stay. This remote role supports the Case Management department and is ideal for experienced nurses.

Requires a nursing degree and an active RN license, with 4+ years of clinical experience and utilization review exposure. OR/ICU/ER experience is a plus; pay range is listed with full-time remote work in CA.

Qualifications

• RN license active in the operating state; LVN/LPN permitted where allowed by state.
• 4+ years of recent clinical experience in healthcare settings.
• Prospective, concurrent, and retrospective utilization review experience preferred; OR/ICU/ER/orthopedics experience is a plus.

Responsibilities

• Identify necessity of the review process and flag issues to claims staff or customer.
• Collect data and analyze information to decide on certification or denial of treatment.
• Document all work accurately in required systems and files.
• Promote utilization review services with stakeholders and teams.
• Perform additional duties as assigned by the supervisor.

Skills

Clinical experience

Utilization review

Communication skills

Education

Nursing degree (ADN/BSN/BSN-RN)

Job description

About This Role

The Utilization Review Case Manager I gathers demographic and clinical information on patient admissions and treatment, certifies medical necessity, and assigns appropriate lengths of stay while supporting the goals of the Case Management department at CorVel. This remote position is ideal for experienced professionals in the nursing field.

Highlights

• Pay: $63,739 - $95,264/year
• Location: Remote, CA
• Department/Unit: Case Management
• Schedule: Full-time

What You'll Do

• Identify the necessity of the review process and communicate issues of concern to claims staff/customer.
• Collect data and analyze information to make decisions regarding certification or denial of treatment.
• Document all work in the appropriate manner.
• Promote utilization review services with stakeholders.
• Perform additional duties as assigned.

Requirements

Education

• Graduate of accredited school of nursing with an associate's degree, Bachelor of Science degree, or Bachelor of Science in Nursing required.

Experience

• 4 or more years of recent clinical experience required.
• Prospective, concurrent, and retrospective utilization review experience preferred.
• Experience in clinical areas such as OR, ICU, CCU, ER, and/or orthopedics preferred.

Licenses & Certifications

• Current Nursing licensure in the state of operation required; RN is required unless local state regulations permit LVN/LPN.

Benefits

• 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 and ROTH 401K
• Paid time off

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. Founded in 1987 and publicly traded since 1991, CorVel invests in human capital and technology to deliver innovative and integrated solutions to clients. With over 4,000 employees, they embrace core values of Accountability, Commitment, Excellence, Integrity, and Teamwork (ACE-IT!).