CA Utilization Review Nurse I

Utilization Review NurseThe 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/customerCollects data and analyzes information to make decisions regarding certification or denial of treatmentDocuments all work in the appropriate mannerPromotes utilization review services with stakeholdersComplies with all safety rules and regulations during work hours in conjunction with the Injury and Illness Prevention Program (IIPP)Additional duties as assignedKnowledge & Skills:Must have thorough knowledge of both CPT and ICD codingAbility to interface with claims staff, attorneys, physicians and their representatives, as well as advisors/clients and coworkersEffective organization skills in a high-volume, fast-paced environmentStrong time management skills with the ability to meet designated deadlinesExcellent written and verbal communication skillsAbility to work both independently and within a team environmentStrong interpersonal skillsAbility to utilize Microsoft Office including Excel spreadsheetsKnowledge of the workers' compensation claims process preferredKnowledge of outpatient utilization review preferredEducation & Experience:Graduate of accredited school of nursing with an associate's degree, Bachelor of Science degree or Bachelor of Science in NursingCurrent Nursing licensure in the state of operation required; RN is required unless local state regulations permit LVN/LPN4 or more years of recent clinical experienceProspective, concurrent, and retrospective utilization review experience preferredExperience in the clinical areas of OR, ICU, CCU, ER and/or orthopedics preferredPay Range: $30.64 - $45.80 per hourCorVel 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.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.