Utilization Review Case Manager I

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.

• Assist in achieving the objectives of the Case Management department and CorVel.

• Assess the need for the review process.

• Relay pertinent issues to the relevant claims personnel and clients.

• Gather and analyze information to make informed decisions regarding the approval or denial of treatment.

• Accurately document all activities conducted.

• Advocate for utilization review services among stakeholders.

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

• Undertake additional responsibilities as assigned.

⛳️ Requirements

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

• Current nursing license in the state of practice is required.

• RN designation is mandatory unless state regulations allow for LVN/LPN.

• Minimum of 4 years of recent clinical experience.

• Comprehensive understanding of CPT and ICD coding.

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

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

• Excellent time management abilities with a knack for meeting deadlines.

• Outstanding written and verbal communication skills.

• Ability to work both independently and as part of a team.

• Strong interpersonal abilities.

• Proficiency in Microsoft Office, including Excel spreadsheets.

• 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 coverage.

• Dental insurance.

• Vision insurance.

• Long Term Disability coverage.

• Health Savings Account.

• Options for Flexible Spending Accounts.

• Life Insurance.

• Accident Insurance.

• Critical Illness Insurance.

• Pre-paid Legal Insurance.

• Parking and Transit FSA accounts.

• 401K plan.

• ROTH 401K plan.

• Paid time off.

• Opportunities for career advancement.

• Remote work options.