Utilization Review Case Manager I

CorVel Corporation; Rancho Cucamonga (CA); Remote; USD 64,000 - 95,000; Full time

Benefits offered by this job

Medical (HDHP) w/Pharmacy

Dental

Vision

401K

Paid time off

Job summary

CorVel Corporation is seeking a Utilization Review Case Manager for a remote role. The incumbent gathers demographic and clinical information for inpatient and outpatient treatment, certifies medical necessity, and assigns length of stay to support the Case Management department.

Essential duties include data collection and analysis for certification decisions, thorough documentation, and collaboration with claims staff and physicians.

Qualifications

• Graduate of accredited nursing program with an associate or BSN.
• Current RN licensure required; LVN/LPN permitted per state rules.
• 4+ years of recent clinical experience.
• Prospective, concurrent, and retrospective utilization review experience preferred.

Responsibilities

• Identify necessity of review process and communicate issues to claims staff.
• Collect data and analyze information to decide certification or denial of treatment.
• Document all work properly.
• Promote utilization review services with stakeholders.
• Perform additional duties as assigned.

Skills

CPT/ICD coding

communication skills

organizational skills

time management

written/verbal communication

teamwork ability

MS Office (Excel)

workers’ compensation knowledge

outpatient utilization review

Education

RN licensure (state of operation)

BSN/ASN or ADN

Tools

Microsoft Office (Excel)

Job description

The Utilization Review Case Manager gathers demographic and clinical information on prospective, concurrent and retrospective in-patient admissions and out-patient treatment, certifies the medical necessity and assigns an appropriate length of stay while supporting the goals of the Case Management department and of CorVel.

This is a remote position.

Essential Functions & 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
• Additional duties as assigned

Knowledge & Skills

• Must have thorough knowledge of both CPT and ICD coding
• Ability to interface with claims staff, attorneys, physicians and their representatives, as well as advisors/clients and coworkers
• Effective organization skills in a high-volume, fast-paced environment
• Strong time management skills with the ability to meet designated deadlines
• Excellent written and verbal communication skills
• Ability to work both independently and within a team environment
• Strong interpersonal skills
• Ability to utilize Microsoft Office including Excel spreadsheets
• Knowledge of the workers’ compensation claims process preferred
• Knowledge of outpatient utilization review preferred

Education & Experience

• 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 the clinical areas of OR, ICU, CCU, ER and/or orthopedics preferred

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 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: $63,739 – $95,264

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

In general, our opportunities will be posted for up to 1 year from date of posting, or until we have selected candidate(s) to fulfill the opening, whichever comes first.

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.

• 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
• paid time off

Equal Opportunity Employer

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