Utilization Review Case Manager I

CorVel Corporation

. Gather demographic and clinical information on prospective, concurrent, and retrospective inpatient admissions and outpatient treatment .

Posted 10/16/2026full-timeRemote • California • United StatesMid-LevelSenior💰 $31 - $46 per hourWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in clinical assessment and utilization review, with a strong foundation in CPT and ICD coding. Capable of effective communication and collaboration with diverse stakeholders while maintaining compliance with safety regulations.

Highest-signal resume keywords

Current Nursing LicensureCPT and ICD Coding KnowledgeUtilization Review ExperienceClinical Experience in OR, ICU, CCU, ER, and/or OrthopedicsMicrosoft Office Proficiency

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Clinical AssessmentUtilization ReviewCPT CodingICD CodingData AnalysisCertification Decision MakingDocumentationLength of Stay AssignmentInpatient AdmissionsOutpatient Treatment

Soft Skills

Effective Organization SkillsTime ManagementWritten CommunicationVerbal CommunicationInterpersonal Skills

Tools & Technologies

Microsoft OfficeExcel Spreadsheets

Certifications & Qualifications

Associate’s Degree in NursingBachelor of Science in NursingRN License

Industry Keywords

Workers’ Compensation Claims ProcessOutpatient Utilization ReviewProspective Utilization ReviewConcurrent Utilization ReviewRetrospective Utilization Review

About the role

Key responsibilities & impact

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 make certification or denial decisions regarding treatment
Document all work appropriately
Promote utilization review services with stakeholders
Comply with safety rules and regulations during work hours in conjunction with the Injury and Illness Prevention Program
Perform additional duties as assigned

Requirements

What you’ll need

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
Clinical experience in OR, ICU, CCU, ER, and/or orthopedics preferred

Benefits

Comp & perks

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
Remote work