CA Utilization Review Case Manager I

$60,840 - $90,938/Yr

CorVel - Rancho Cucamonga, CA

Full-time - Entry Level

Remote - Rancho Cucamonga, CA

1,001-5,000 employees

Professional, Scientific, and Technical Services

About the position

The Utilization Review Case Manager I is responsible for gathering demographic and clinical information on in-patient admissions and out-patient treatments, certifying medical necessity, and assigning appropriate lengths of stay. This role supports the goals of the Case Management department at CorVel and offers the opportunity to work remotely, provided candidates reside in the Pacific Time Zone.

Responsibilities

• Identifies the necessity of the review process and communicates specific issues to claims staff/customer.
• Collects data and analyzes information to make decisions regarding certification or denial of treatment.
• Documents all work appropriately.
• Requires regular and consistent attendance.
• Complies with all safety rules and regulations during work hours.

Requirements

• Graduate of an 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.
• Thorough knowledge of both CPT and ICD coding.

Nice-to-haves

• Previous experience in prospective, concurrent, and retrospective utilization review.
• Experience in clinical areas such as O.R., I.C.U., C.C.U., E.R., orthopedics.
• Knowledge of the workers' compensation claims process.

Benefits

• 401(k)
• Dental insurance
• Disability insurance
• Flexible spending account
• Health insurance
• Health savings account
• Life insurance