Utilization Review Specialist

2 days ago


Central Islip, New York, United States CorVel Corporation Full time
Job Summary

The Utilization Review Case Manager plays a critical role in ensuring the medical necessity of in-patient admissions and out-patient treatment. This position requires a strong understanding of clinical information and the ability to analyze data to make informed decisions.

Key Responsibilities
  • Collect and analyze demographic and clinical information to determine medical necessity
  • Communicate with claims staff, attorneys, physicians, and their representatives to gather information and resolve issues
  • Document all work in the appropriate manner
  • Meet designated deadlines and maintain regular attendance
  • Comply 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
  • 4 or more years of recent clinical experience
  • Previous experience in prospective, concurrent, and retrospective utilization review, clinical areas of O.R., I.C.U., C.C.U., E.R., orthopedics, and workers' compensation claims process
Benefits

CorVel offers a comprehensive benefits package, including medical, 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.

About CorVel

CorVel is a national provider of industry-leading risk management solutions for the workers' compensation, auto, health, and disability management industries. We are a stable and growing company with a strong, supportive culture and plenty of career advancement opportunities.


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