The Utilization Review Case Manager gathers demographic and clinical information
on prospective, concurrent and retrospective in-patient admissions and
out-patient treatment, certifies the medical necessity and assigns an
appropriate length of stay while supporting the goals of the Case Management
department and of CorVel.
This is a remote position
ESSENTIAL FUNCTIONS & RESPONSIBILITIES:
Identifies the necessity of the review process and communicates issues of
concern to the appropriate claims staff/customer
Collects data and analyzes information to make decisions regarding
certification or denial of treatment
Documents all work in the appropriate manner
Promotes utilization review services with stakeholders
Additional duties as assigned
KNOWLEDGE & SKILLS:
Must have thorough knowledge of both CPT and ICD coding
Ability to interface with claims staff, attorneys, physicians and their
representatives, as well as advisors/clients and coworkers
Effective organization skills in a high-volume, fast-paced environment
Strong time management skills with the ability to meet designated deadlines
Excellent written and verbal communication skills
Ability to work both independently and within a team environment
Strong interpersonal skills
Ability to utilize Microsoft Office including Excel spreadsheets
Knowledge of the workers’ compensation claims process preferred
Knowledge of outpatient utilization review preferred
EDUCATION & EXPERIENCE:
Graduate of accredited school of nursing with an associate’s degree, Bachelor
of Science degree or Bachelor of Science in Nursing
Current Nursing licensure in the state of operation required; RN is required
unless local state regulations permit LVN/LPN
4 or more years of recent clinical experience
Prospective, concurrent, and retrospective utilization review experience
preferred
Experience in the clinical areas of OR, ICU, CCU, ER and/or orthopedics
preferred
PAY RANGE
CorVel uses a market based approach to pay and our salary ranges may vary
depending on your location. Pay rates are established taking into account the
following factors: federal, state, and local minimum wage requirements, the
geographic location differential, job-related skills, experience,
qualifications, internal employee equity, and market conditions. Our ranges may
be modified at any time.
For leveled roles (I, II, III, Senior, Lead, etc.) new hires may be slotted into
a different level, either up or down, based on assessment during interview
process taking into consideration experience, qualifications, and overall fit
for the role. The level may impact the salary range and these adjustments would
be clarified during the offer process.
Pay Range: $63,739 – $95,264
A list of our benefit offerings can be found on our CorVel website: CorVel
Careers | Opportunities in Risk Management
[https://www.corvel.com/company/careers/]
In general, our opportunities will be posted for up to 1 year from date of
posting, or until we have selected candidate(s) to fulfill the opening,
whichever comes first.
ABOUT CORVEL:
CorVel, a certified Great Place to Work® Company, is a national provider of
industry-leading risk management solutions for the workers’ compensation, auto,
health and disability management industries. CorVel was founded in 1987 and
has been publicly traded on the NASDAQ stock exchange since 1991. Our continual
investment in human capital and technology enable us to deliver the most
innovative and integrated solutions to our clients. We are a stable and growing
company with a strong, supportive culture and plenty of career advancement
opportunities. Over 4,000 people working across the United States embrace our
core values of Accountability, Commitment, Excellence, Integrity and Teamwork
(ACE-IT!).
A comprehensive benefits package is available for full-time regular employees
and includes Medical (HDHP) w/Pharmacy, Dental, Vision, 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, and paid time off.
CorVel is an Equal Opportunity Employer, drug free workplace, and complies with
ADA regulations as applicable.
#LI-Remote