1 hybrid jobs found in Boxborough, MA

The Utilization Review Case Manager 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 hybrid role.  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 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...