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 role.
ESSENTIAL FUNCTIONS & RESPONSIBILITIES:
Identifies the necessity of the review process and communicates any specific 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 a thorough knowledge of both CPT and ICD coding
Ability to interface with claims staff, attorneys, physicians and their representatives, and advisors/clients and coworkers
Strong ability to negotiate provider fees effectively
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
EDUCATION & EXPERIENCE:
Graduate of accredited school of nursing with a diploma/Associates degree (Bachelor of Science degree or Bachelor of Science in Nursing preferred)
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
Previous experience in the following areas, preferred:
Prospective, concurrent, and retrospective utilization review
Experience in the clinical areas of O.R., I.C.U., C.C.U., E.R., orthopedics
Knowledge of the workers’ compensation claims process
Outpatient utilization review
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.
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.
Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.