The Utilization Review Nurse 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 while supporting the goals of the Case Management department and of CorVel.
This is a remote position.
ESSENTIAL FUNCTIONS & 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
KNOWLEDGE & SKILLS:
- 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
- Knowledge of the workers’ compensation claims process preferred
- Knowledge of outpatient utilization review preferred
EDUCATION & EXPERIENCE:
- 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
- Prospective, concurrent, and retrospective utilization review experience preferred
- Experience in the clinical areas of OR, ICU, CCU, ER and/or orthopedics preferred
PAY RANGE:
CorVel uses a market based approach to pay and our salary ranges may vary depending on your location. Pay rates are established taking into account the following factors: federal, state, and local minimum wage requirements, the geographic location differential, job-related skills, experience, qualifications, internal employee equity, and market conditions. Our ranges may be modified at any time.
For leveled roles (I, II, III, Senior, Lead, etc.) new hires may be slotted into a different level, either up or down, based on assessment during interview process taking into consideration experience, qualifications, and overall fit for the role. The level may impact the salary range and these adjustments would be clarified during the offer process.
Pay Range: $30.64 - $45.80 per hour
A list of our benefit offerings can be found on our CorVel website: CorVel Careers | Opportunities in Risk Management
In general, our opportunities will be posted for up to 1 year from date of posting, or until we have selected candidate(s) to fulfill the opening, whichever comes first.
ABOUT CORVEL:
CorVel, a certified Great Place to Work® Company, is a national provider of industry-leading risk management solutions for the workers’ compensation, auto, health and disability management industries. CorVel was founded in 1987 and has been publicly traded on the NASDAQ stock exchange since 1991. Our continual investment in human capital and technology enable us to deliver the most innovative and integrated solutions to our clients. We are a stable and growing company with a strong, supportive culture and plenty of career advancement opportunities. Over 4,000 people working across the United States embrace our core values of Accountability, Commitment, Excellence, Integrity and Teamwork (ACE-IT!).
A comprehensive benefits package is available for full-time regular employees and includes 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, and paid time off.
CorVel is an Equal Opportunity Employer, drug free workplace, and complies with ADA regulations as applicable.
#LI-Remote
Equal Opportunity EmployerThis employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.
Skills Required
- Current Nursing licensure in the state of operation required; RN is required unless local state regulations permit LVN/LPN
- Graduate of accredited school of nursing with an associate's degree, Bachelor's or Bachelor of Science in Nursing
- 4 or more years of recent clinical experience
- Thorough knowledge of both CPT and ICD coding
- Prospective, concurrent, and retrospective utilization review experience preferred
CorVel Corporation Compensation & Benefits Highlights
The following summarizes recurring compensation and benefits themes identified from responses generated by popular LLMs to common candidate questions about CorVel Corporation and has not been reviewed or approved by CorVel Corporation.
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Wellbeing & Lifestyle Benefits — Work-from-home options and schedule flexibility are highlighted as meaningful offsets to lower base pay in certain roles. An Employee Assistance Program and related resources further support everyday wellbeing.
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Flexible Benefits — Multiple medical plan choices with dental/vision and a broad suite of supplemental coverages offer choice tailored to role and location needs. An HSA option with a company match adds flexibility in how healthcare expenses are managed.
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Retirement Support — A 401(k) with a company match is part of the core package.
CorVel Corporation Insights
What We Do
CorVel is a leader of risk and healthcare management solutions to employers, third party administrators, insurance companies and government agencies. We are publicly traded and annual revenues exceeded $595 million in FY2019. Our continued customer growth is a testament to our financial stability and our significant investments in new systems and technologies allows us to continue to deliver industry-leading solutions to the marketplace. CorVel has approximately 3,500 associates who serve customers through a national branch office network covering all 50 states.
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