Raising the bar for care. Lowering risk for clients.
Utilization Review Case Manager I - RN
Location
United States
Posted
43 days ago
Salary
$63.7K - $95.3K / year
Seniority
Lead
No structured requirement data.
Job Description
Utilization Review Case Manager I - RN
CorVel Corporation
Role 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 role. 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 Qualifications - 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 Requirements - 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 Benefits - CorVel uses a market based approach to pay and our salary ranges may vary depending on your location. - Pay Range: $63,739 - $95,264 - 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 - Paid time off
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