CA UR Case Manager II

About the role

This is a remote position. 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.

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
• Complies with all safety rules and regulations during work hours in conjunction with the Injury and Illness Prevention Program (IIPP)
• Additional duties as assigned

Requirements

• 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

Skills

• 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

Pay

CorVel uses a market-based approach to pay. Pay rates are established taking into account federal, state, and local minimum wage requirements, the geographic location differential, job-related skills, experience, qualifications, internal employee equity, and market conditions. The pay range for this role is $32.18 - $48.68 per hour.

Benefits

A comprehensive benefits package is available for full-time regular employees and includes:

• Medical (HDHP) with 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 and ROTH 401K
• Paid time off

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. With over 4,000 employees across the United States, CorVel embraces core values of Accountability, Commitment, Excellence, Integrity, and Teamwork (ACE-IT!).