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 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: