CA UR Case Manager I jobs in United States
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CorVel Corporation · 2 months ago

CA UR Case Manager I

CorVel Corporation is a national provider of risk management solutions for the workers’ compensation and healthcare industries. The Utilization Review Case Manager is responsible for gathering clinical information, certifying medical necessity, and supporting the goals of the Case Management department.

InsuranceSoftware

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
Complies with all safety rules and regulations during work hours in conjunction with the Injury and Illness Prevention Program (IIPP)
Additional duties as assigned

Qualification

CPT codingICD codingNursing licensureUtilization reviewMicrosoft OfficeTime managementCommunication skillsInterpersonal skillsOrganizational skills

Required

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
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

Preferred

Knowledge of the workers' compensation claims process preferred
Knowledge of outpatient utilization review preferred
Prospective, concurrent, and retrospective utilization review experience preferred
Experience in the clinical areas of OR, ICU, CCU, ER and/or orthopedics preferred

Benefits

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
Paid time off

Company

CorVel Corporation

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CorVel is a nationally recognized claims management and managed care provider with over 30 years of experience in the industry.

Funding

Current Stage
Public Company
Total Funding
unknown
1991-07-05IPO

Leadership Team

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Jeff Gurtcheff
Chief Claims Officer
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Maxim Shishin
CIO
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Company data provided by crunchbase