Job Description
**Utilization Review Case Manager**
We are seeking a dedicated Utilization Review Case Manager to join our team. This role involves gathering demographic and clinical information for both in-patient and out-patient treatments, ensuring medical necessity, and assigning appropriate lengths of stay. You will play a crucial role in supporting our Case Management department and our overall organizational goals.
**Location:** Opportunity to work from home. Candidates must reside in the Pacific Time Zone.
**Essential Functions & Responsibilities:**
- Identify the necessity of the review process and communicate specific issues to the appropriate claims staff or customers.
- Collect and analyze data to make informed decisions regarding treatment certification or denial.
- Document all work accurately and consistently.
- Maintain regular and consistent attendance.
- Adhere to all safety rules and regulations, including the Injury and Illness Prevention Program (IIPP).
- Perform additional duties as required.
**Knowledge & Skills:**
- Thorough knowledge of 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, as well as advisors/clients and coworkers.
- Promote and market utilization review products with attorneys and claims staff.
- Strong negotiation skills for provider fees.
- Excellent written and verbal communication skills.
- Ability to meet designated deadlines.
- Proficiency in computer applications, including MS Office and Excel spreadsheets.
- Strong interpersonal, time management, and organizational skills.
- Ability to work independently and within a team environment.
**Education & Experience:**
- Graduate of an 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 is preferred:
- Prospective, concurrent, and retrospective utilization review.
- Clinical areas such as O.R., I.C.U., C.C.U., E.R., orthopedics.
- Knowledge of the workers' compensation claims process.
- Outpatient utilization review.
**Pay Range:**
Our pay rates are established based on a market-based approach, taking into account various factors such as federal, state, and local minimum wage requirements, geographic location, job-related skills, experience, qualifications, internal employee equity, and market conditions. Pay 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 based on assessment during the interview process, considering 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:** $29.25 - $43.72 per hour
**Benefits:**
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.
**About Us:**
We are a national provider of industry-leading risk management solutions for various industries. Founded in 1987, we have been publicly traded since 1991. Our continual investment in human capital and technology enables us to deliver 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. Our core values are Accountability, Commitment, Excellence, Integrity, and Teamwork (ACE-IT!).
We are an Equal Opportunity Employer, a drug-free workplace, and comply with ADA regulations as applicable.
**Apply Now:**
Our opportunities will be posted for up to 1 year from the date of posting, or until we have selected candidate(s) to fulfill the opening, whichever comes first.
Employment Type: Full-Time
Salary: $ 29.00 44.00 Per Hour
Job Tags
Hourly pay, Minimum wage, Full time, Local area, Work from home, Flexible hours,