Utilization Review Specialist

2 weeks ago


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

CorVel Corporation is seeking a skilled Utilization Review Case Manager I to join our team. As a key member of our Case Management department, you will play a critical role in ensuring the medical necessity of in-patient admissions and out-patient treatment.

Key Responsibilities
  • Conduct thorough reviews of patient information to determine medical necessity and assign appropriate lengths of stay.
  • Collaborate with claims staff, attorneys, physicians, and other stakeholders to ensure seamless communication and effective case management.
  • Utilize strong analytical and problem-solving skills to identify and address potential issues.
  • Develop and maintain strong relationships with healthcare providers and other stakeholders to promote effective case management.
  • Stay up-to-date with industry developments and best practices in case management and utilization review.
Requirements
  • Graduate of an accredited school of nursing with a diploma or 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 utilization review, case management, or a related field preferred.
What We Offer

CorVel Corporation offers a comprehensive benefits package, including medical, dental, and vision insurance, 401(k) and ROTH 401(k) plans, and paid time off. We are an equal opportunity employer and comply with ADA regulations as applicable.



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