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The Case Manager gathers clinical information to certify medical necessity and determine appropriate lengths of stay for patient admissions. They also communicate with stakeholders and document all review activities to support the goals of the Case Management department.
Requirements summary
Candidates must be a graduate of an accredited nursing school with a current RN license and at least four years of recent clinical experience. Proficiency in CPT and ICD coding is required, along with strong organizational and communication skills.
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
Benefits
Accident Insurance
Critical Illness Insurance
Life Insurance
Medical
Dental
Vision
Paid Time Off
Health Savings Account
Flexible Spending Account
401k
Long Term Disability
Pharmacy
Roth 401k
Pre-paid Legal Insurance
Parking and Transit FSA
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
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.
