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Utilization Review Case Mgmt Nurse I

Employer
CorVel Corporation
Location
Santa Ana, California
Salary
Not Specified
Closing date
Aug 24, 2019

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Category
Health and Medical
Job Type
Full Time
Career Level
Not Specified

Job Details

JOB SUMMARY:

The CorVel office in Orange is seeking a full time Utilization Review Case Manager. The Utilization Review Case Manager gathers demographic and clinical information on prospective, concurrent and retrospective in-patient admissions and out-patient treatment, certifies the medical necessity and assigns an appropriate length of stay; supporting the goals of the Case Management department, and of CorVel.

ESSENTIAL FUNCTIONS AND RESPONSIBILITIES:

  • Identifies the necessity of the review process and communicates any specific issues of concern to the appropriate claims staff/customer.
  • Collects data and analyzes information to make decisions regarding certification or denial of treatment. Documenting all work in the appropriate manner.
  • Requires regular and consistent attendance.
  • Complies with all safety rules and regulations during work hours in conjunction with the Injury and Illness Prevention Program (IIPP).
  • Additional duties as required.

KNOWLEDGE & SKILLS:

  • Must have a thorough knowledge of both CPT and ICD coding.
  • Effective multi-tasking skills in a high-volume, fast-paced, team-oriented environment.
  • Ability to interface with claims staff, attorneys, physicians and their representatives, and advisors/clients and coworkers.
  • Ability to promote and market utilization review products with attorneys and claims staff.
  • Strong ability to negotiate provider fees effectively.
  • Excellent written and verbal communication skills.
  • Ability to meet designated deadlines
  • Computer proficiency and technical aptitude with the ability to utilize MS Office including Excel spreadsheets
  • Strong interpersonal, time management and organizational skills.
  • Ability to work both independently and within a team environment.

EDUCATION/EXPERIENCE:

  • Graduate of 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.
  • RN is required unless local state regulations permit LVN/LPN.
  • 4 or more years of recent clinical experience.
  • Previous experience in the following areas, preferred:
      • Prospective, concurrent and retrospective utilization review
      • Experience in the clinical areas of O.R., I.C.U., C.C.U., E.R., orthopedics
      • Knowledge of the workers compensation claims process
      • Outpatient utilization review

Company

CorVel is looking for passionate, motivated individuals to join our team of associates and help us be successful by making a positive impact within our organization and for our clients. If you are interested in joining CorVel, review our available opportunities and submit your resume as indicated by the application instructions.

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