Utilization Review Case Manager – I

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

📋 Description

• Collect demographic and clinical information pertaining to prospective, concurrent, and retrospective 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.

• Communicate any issues of concern to the relevant claims personnel and clients.

• Gather data and evaluate information to make decisions on certification or denial regarding treatment.

• Accurately document all tasks performed.

• Advocate for utilization review services with stakeholders.

• Undertake additional responsibilities as assigned.

⛳️ Requirements

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

• Active nursing license in the state of operation is required; RN is necessary unless local regulations allow 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 skills in a high-volume, fast-paced setting.

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

• Outstanding written and verbal communication abilities.

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

• Strong interpersonal abilities.

• Proficiency in Microsoft Office, including Excel spreadsheets.

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

• Knowledge of outpatient utilization review is preferred.

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

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

🏝️ Benefits

• Medical (HDHP) along 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.

• Remote work opportunities.

• Opportunities for career advancement.

• Supportive workplace culture.

• Recognized as a Great Place to Work® Company.