Case Manager II
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Job Description
Remote Utilization Review Case Manager gathering clinical data and certifying treatment necessity. Supporting CorVel’s workers’ compensation and healthcare risk-management services.
Responsibilities:
- Gather demographic and clinical information on prospective, concurrent, and retrospective inpatient admissions and outpatient treatment
- Certify medical necessity and assign an appropriate length of stay
- Support the goals of the Case Management department and CorVel
- Identify the necessity of the review process
- Communicate issues of concern to appropriate claims staff and customers
- Collect data and analyze information to decide on certification or denial of treatment
- Document all work appropriately
- Promote utilization review services with stakeholders
- Comply with safety rules and regulations during work hours under the Injury and Illness Prevention Program
- Perform additional duties as assigned
Requirements:
- Graduate of an 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 required unless local state regulations permit LVN/LPN
- 4 or more years of recent clinical experience
- Thorough knowledge of CPT and ICD coding
- Ability to interface with claims staff, attorneys, physicians and their representatives, advisors/clients, and coworkers
- Effective organization skills in a high-volume, fast-paced environment
- Strong time management skills and ability to meet designated deadlines
- Excellent written and verbal communication skills
- Ability to work independently and within a team environment
- Strong interpersonal skills
- Ability to utilize Microsoft Office, including Excel spreadsheets
- Knowledge of the workers’ compensation claims process preferred
- Knowledge of outpatient utilization review preferred
- Prospective, concurrent, and retrospective utilization review experience preferred
- Experience in clinical areas of OR, ICU, CCU, ER and/or orthopedics preferred
Benefits:
- Medical (HDHP) with Pharmacy
- Dental insurance
- Vision insurance
- 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
- Career advancement opportunities
- Supportive culture
- Equal Opportunity Employer
- Drug-free workplace
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