Case Manager II

This is a fully remote position, open to applicants in California.

📋 Description

• Collect demographic and clinical data on potential, ongoing, and historical inpatient admissions as well as outpatient treatments.

• Validate medical necessity and determine an appropriate length of stay.

• Align with the objectives of the Case Management department and CorVel.

• Assess the need for the review process.

• Relay any concerns to the relevant claims personnel and clients.

• Gather and analyze data to make decisions regarding certification or denial.

• Accurately document all activities performed.

• Advocate for utilization review services among stakeholders.

• Adhere to safety protocols and regulations during work hours in accordance with the Injury and Illness Prevention Program.

• Execute additional responsibilities as assigned.

⛳️ Requirements

• Graduate from an accredited nursing program with either an associate’s degree, Bachelor of Science degree, or Bachelor of Science in Nursing.

• Current nursing license in the operational state is mandatory.

• RN certification is required unless local state regulations allow for LVN/LPN.

• Minimum of 4 years of recent clinical experience.

• Comprehensive understanding of CPT and ICD coding.

• Capability to interact effectively with claims staff, attorneys, physicians and their representatives, advisors/clients, and colleagues.

• Strong organizational abilities in a high-volume, fast-paced setting.

• Excellent time management skills with a proven ability to meet deadlines.

• Superior written and verbal communication skills.

• Ability to work autonomously as well as part of a team.

• Strong interpersonal abilities.

• Proficiency in Microsoft Office, including Excel.

• Familiarity with the workers’ compensation claims process is preferred.

• Understanding of outpatient utilization review is preferred.

• Experience in prospective, concurrent, and retrospective utilization review is preferred.

• Clinical experience in OR, ICU, CCU, ER, and/or orthopedics is preferred.

🏝️ Benefits

• Medical (HDHP) with Pharmacy.

• Dental insurance.

• Vision insurance.

• 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.

• 401(k).

• Roth 401(k).

• Paid time off.

• Opportunities for career advancement.

• Supportive workplace culture.