Utilization Review Case Manager – I

🕒 Outubro 30

🏄 California – Remoto

🏄 California – Remote

💵 $63.739 - $95.264 / ano

⏰ Tempo Integral

🟡 Pleno

🟠 Sênior

👔 Gerente

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CorVel Corporation

SiteLinkedInTodas as Vagas

1001 - 5000 funcionários

Fundada em 1987

🏥 Saúde

💼 Consultoria

📦 Logística

Healthcare • Consulting • Logistics

A CorVel Corporation é uma empresa de gestão de riscos e serviços de saúde que fornece soluções integradas de sinistros e cuidados para pagadores e empregadores. Especializa-se em gestão de compensação de trabalhadores, responsabilidade civil e invalidez, redes de provedores e farmácias, e soluções alternativas de risco, além de oferecer plataformas tecnológicas que utilizam IA e análise de dados para agilizar a administração de sinistros, melhorar resultados e reduzir custos.

Descrição

• Gather demographic and clinical information on prospective, concurrent, and retrospective inpatient admissions and outpatient treatment • Certify medical necessity and assign an appropriate length of stay • Support the goals of the Case Management department and CorVel • Identify the necessity of the review process • Communicate issues of concern to appropriate claims staff and customers • Collect data and analyze information to make certification or denial decisions regarding treatment • Document all work appropriately • Promote utilization review services with stakeholders • Perform additional duties as assigned

🎯 Requisitos

• Graduate of an 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 • Thorough knowledge of CPT and ICD coding • Ability to interface with claims staff, attorneys, physicians and their representatives, 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 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 • Prospective, concurrent, and retrospective utilization review experience preferred • Experience in OR, ICU, CCU, ER and/or orthopedics preferred

🏖️ Benefícios

• 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 • Remote work • Career advancement opportunities • Supportive culture • Great Place to Work® Company

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