Utilization Review Case Manager I

🔥 12 hours ago

🏄 California – Remote

🏄 California – Remote

💵 $30 - $45 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

👔 Manager

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 0%

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CorVel Corporation

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1987

🏥 Healthcare

💼 Consulting

📦 Logistics

Healthcare • Consulting • Logistics

CorVel Corporation is a risk management and healthcare services company that provides integrated claims and care solutions for payors and employers. It specializes in workers' compensation, liability and disability management, provider and pharmacy networks, and alternative risk solutions, and it offers technology platforms that use AI and data analytics to streamline claims administration, improve outcomes, and reduce costs.

📋 Description

• 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/customers • Collect data and analyze information to make certification or denial decisions • Document all work appropriately • Promote utilization review services with stakeholders • Comply with safety rules and regulations during work hours in conjunction with the Injury and Illness Prevention Program • Perform additional duties as assigned

🎯 Requirements

• 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 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 • 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 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 OR, ICU, CCU, ER and/or orthopedics preferred • Knowledge of the workers’ compensation claims process preferred • Knowledge of outpatient utilization review 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 • Career advancement opportunities • Comprehensive benefits package for full-time regular employees • Remote work