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Utilization Review Case Manager
4 months ago
The Utilization Review Case Manager is responsible for reviewing inpatient and outpatient medical treatment to ensure its medical necessity and assigning appropriate length of stay. This is a remote position for candidates living in Pacific Time Zone.
Essential Functions & Responsibilities:
- Communicate specific issues of concern with the appropriate claims staff or customer;
- Analyze and evaluate data to make decisions regarding certification or denial of treatment and document the work accordingly;
- Meet designated deadlines;
- Market utilization review products with attorneys and claims staff;
- Manage negotiations with providers effectively;
- Comply with all safety rules and regulations.
Knowledge & Skills:
- Thorough knowledge of CPT and ICD coding;
- Ability to multitask effectively in a fast-paced environment;
- Strong interpersonal, written, and verbal communication skills;
- Ability to work independently as well as within a team environment
- Proficiency in MS Office, including Excel spreadsheets;
Education & Experience:
- Graduate of accredited school of nursing with a diploma/Associates degree (BSN preferred);
- Current Nursing licensure required;
- Minimum of 4 years' experience in clinical setting needed;
- Experience in prospective, concurrent and retrospective utilization review preferred;
- Knowledge of the workers' compensation claims process a plus;
- Outpatient utilization review experience helpful.
Pay Range:
The pay range for this position varies and will be determined using a market-based approach, taking into account factors such as experience, qualifications, and job-related skills.
About CorVel
CorVel is a national provider of risk management solutions in the workers' compensation, auto, health, and disability management industries, publicly traded on NASDAQ. We offer a supportive culture, opportunities for advancement, a comprehensive benefits package, and embrace core values including Accountability, Commitment, Excellence, Integrity and Teamwork.
A comprehensive benefits package is available for full-time 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 and a drug-free workplace that complies with ADA regulations as applicable.
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