Utilization Review Case Manager I

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

📋 Description

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

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

• Support the objectives of the Case Management department and CorVel.

• Assess the need for the review process.

• Relay issues of concern to the appropriate claims personnel or customers.

• Collect data and analyze information to inform certification or denial decisions.

• Document all activities in an appropriate manner.

• Advocate for utilization review services among stakeholders.

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

• Carry out additional responsibilities as assigned.

⛳️ Requirements

• In-depth knowledge of CPT and ICD coding.

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

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

• Excellent time management skills with the capability to meet specified deadlines.

• Outstanding written and verbal communication abilities.

• Capacity to work independently as well as collaboratively within a team.

• Strong interpersonal skills.

• Proficiency in Microsoft Office, including Excel spreadsheets.

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

• Current nursing licensure in the state of practice is required; RN required unless local regulations allow LVN/LPN.

• Four or more years of recent clinical experience.

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

• Background in operating room, ICU, CCU, ER, and/or orthopedics is preferred.

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

• Understanding of outpatient utilization review 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.

• Comprehensive benefits package for full-time regular employees.

• Remote work.