Case Manager II

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

📋 Description

• Collect demographic and clinical details regarding prospective, concurrent, and retrospective inpatient admissions as well as outpatient treatment.

• 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 issues of concern to the corresponding claims staff and clients.

• Gather data and analyze information to make decisions regarding the certification or denial of treatment.

• Accurately document all activities performed.

• Advocate for utilization review services among stakeholders.

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

• Carry out additional responsibilities as assigned.

⛳️ Requirements

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

• Valid nursing licensure in the operating state is required; RN is mandatory unless local regulations allow LVN/LPN.

• Minimum of 4 years of recent clinical experience.

• Comprehensive understanding of CPT and ICD coding.

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

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

• Excellent time management abilities and capability to meet established deadlines.

• Outstanding written and verbal communication skills.

• Proficient in working independently as well as collaboratively within a team.

• Strong interpersonal capabilities.

• Proficiency in Microsoft Office, including Excel spreadsheets.

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

• Knowledge of outpatient utilization review is a plus.

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

• Background in clinical areas such as 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.

• 401K.

• ROTH 401K.

• Paid time off.

• Opportunities for career advancement.

• Supportive workplace culture.

• Equal Opportunity Employer.

• Drug-free workplace.