CA Utilization Review Nurse

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 Cor Vel.

This is a remote position.

• 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

• 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

• 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

Cor Vel 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 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.

Cor Vel is an Equal Opportunity Employer, drug free workplace, and complies with ADA regulations as applicable.