15 medical case manager ii jobs found in Rancho Cucamonga

CorVel Corporation is hiring a caring, self-motivated, energetic and independent registered nurse to fill a Medical Case Manager position in Los Angeles, CA.   Work from home, and on the road. Monday – Friday, regular business hours.   As a Medical Case Manager you will make a meaningful difference in the lives of injured workers and their families.  Your responsibilities include working closely with injured workers to facilitate their recovery. You will work collaboratively with the patient, their family, medical providers, members of our team, and others.  This is a heavy local travel role responsible for working with a caseload of workers compensation injured workers within a defined jurisdiction.   ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Provides in-person and telephonic Medical Case Management to individuals, involving the patient, physician, other health care providers, the employer, and the referral source Utilizes their medical and nursing knowledge to...

The Senior Claims Specialist handles complex and high-profile Workers' Compensation claims following company standards. This role works closely with case managers and attorneys, manages subrogation, and negotiates settlements. The Senior Claims Specialist ensures the best possible outcome for the claim, meeting customer service expectations, and supporting the goals of the Claims Department and CorVel. This is a remote position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Receives claim, confirms policy coverage and acknowledgement of the claim Determines validity and compensability of the claim by investigating and gathering information regarding the claim and files necessary documentation with state agencies Establishes reserves and authorizes payments within reserving authority limits Develops and manages well documented action plans with the case manager and outcomes manager to reduce overall cost of the claim Coordinates early return-to-work efforts with the...

The Senior Claims Specialist handles complex and high-profile Workers' Compensation claims following company standards. This role works closely with case managers and attorneys, manages subrogation, and negotiates settlements. The Senior Claims Specialist ensures the best possible outcome for the claim, meeting customer service expectations, and supporting the goals of the Claims Department and CorVel. This is a remote position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Receives claim, confirms policy coverage and acknowledgement of the claim Determines validity and compensability of the claim by investigating and gathering information regarding the claim and files necessary documentation with state agencies Establishes reserves and authorizes payments within reserving authority limits Develops and manages well documented action plans with the case manager and outcomes manager to reduce overall cost of the claim Coordinates early return-to-work efforts with the...

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 remote position. 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 Complies with all safety rules and regulations during work hours in conjunction with the Injury and Illness Prevention Program (IIPP) Additional duties as assigned   KNOWLEDGE & SKILLS:  Must have thorough knowledge of both CPT and ICD...

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 remote position. 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 Complies with all safety rules and regulations during work hours in conjunction with the Injury and Illness Prevention Program (IIPP) Additional duties as assigned   KNOWLEDGE & SKILLS:  Must have thorough knowledge of both CPT and ICD...

The Claims Supervisor is responsible for supervising a team of direct reports, ensuring all quality, productivity and customer service criteria are met while adhering to company policies and procedures. The Claims Supervisor position is integral to the success of the company and requires regular and consistent attendance, supporting the goals of the claims department and CorVel. This is a remote position. Candidates must hold a Self-Insurance Certification. Must reside in the state of California. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Supervises claims staff in their day-to-day operations Assists Claims Manager with recruitment, interviewing, and onboarding new staff, ensuring proficiency in procedures and job functions Ensures staff compliance with Workers’ Compensation laws and mandated regulatory reporting requirements Ensures optimal team performance through ongoing training, coaching, and regular performance evaluations; recommends merit-based actions...

The Senior Claims Specialist manages within company standards and best practices complex and problematic, high visibility workers' compensation claims within delegated limited authority to determine benefits due; work closely with case managers and attorneys; manage subrogation and negotiate settlements to ensure specific customer service requirement to achieve the best possible outcome in the claim, supporting the goals of claims department and of CorVel. This is a remote position.   ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Receives claim, confirms policy coverage and acknowledgement of the claim Determines validity and compensability of the claim by investigating and gathering information regarding the claim and files necessary documentation with state agencies Establishes reserves and authorizes payments within reserving authority limits Develops and manages well documented action plans with the case manager and outcomes manager to reduce overall cost of the...

CorVel Corporation is hiring a caring, self-motivated, energetic and independent registered nurse to fill a Medical Case Manager position in Los Angeles, CA.   Work from home, and on the road. Monday – Friday, regular business hours.   As a Medical Case Manager you will make a meaningful difference in the lives of injured workers and their families.  Your responsibilities include working closely with injured workers to facilitate their recovery. You will work collaboratively with the patient, their family, medical providers, members of our team, and others.  This is a heavy local travel role responsible for working with a caseload of workers compensation injured workers within a defined jurisdiction.   ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Provides in-person and telephonic Medical Case Management to individuals, involving the patient, physician, other health care providers, the employer, and the referral source Utilizes their medical and nursing knowledge to...

We are seeking a Sr. Claims Specialist for our Southern California Team. The Sr. Claims Specialist manages within company standards and best practices complex and problematic, high visibility workers' compensation claims within delegated limited authority to determine benefits due; work closely with case managers and attorneys; manage subrogation and negotiate settlements to ensure specific customer service requirement to achieve the best possible outcome in the claim, supporting the goals of claims department and of CorVel.  This position is remote. Candidates must hold a self-insured certificate. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Receives claim, confirms policy coverage and acknowledgement of the claim Determines validity and compensability of the claim by investigating and gathering information regarding the claim and files necessary documentation with state agencies Establishes reserves and authorizes payments within reserving authority limits...

We are seeking a Sr. Claims Specialist for our Southern California Team. The Sr. Claims Specialist manages within company standards and best practices complex and problematic, high visibility workers' compensation claims within delegated limited authority to determine benefits due; work closely with case managers and attorneys; manage subrogation and negotiate settlements to ensure specific customer service requirement to achieve the best possible outcome in the claim, supporting the goals of claims department and of CorVel.  This position is remote. Candidates must hold a self-insured certificate. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Receives claim, confirms policy coverage and acknowledgement of the claim Determines validity and compensability of the claim by investigating and gathering information regarding the claim and files necessary documentation with state agencies Establishes reserves and authorizes payments within reserving authority limits...

The Senior Claims Specialist manages within company standards and best practices complex and problematic, high visibility workers' compensation claims within delegated limited authority to determine benefits due; work closely with case managers and attorneys; manage subrogation and negotiate settlements to ensure specific customer service requirement to achieve the best possible outcome in the claim, supporting the goals of claims department and of CorVel. This is a remote position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Receives claim, confirms policy coverage and acknowledgement of the claim Determines validity and compensability of the claim by investigating and gathering information regarding the claim and files necessary documentation with state agencies Establishes reserves and authorizes payments within reserving authority limits Develops and manages well documented action plans with the case manager and outcomes manager to reduce overall cost of the...

  The Telephonic Case Manager coordinates resources and creates flexible, cost-effective options for ill or injured individuals on a case-by-case basis to facilitate quality individualized treatment goals, including timely return-to-work if appropriate. The Telephonic Case Manager will rely on their medical knowledge to evaluate the patient’s current treatment plan for medical appropriateness based on their physical and medical status. The Telephonic Case Manager must be able to discuss the patient’s medical and physical conditions with the treating physicians, along with discussing/ recommending alternate treatment plans for the patient. The Telephonic Case Manager must have the ability to explain medical conditions and treatment plans to the patient, family members and adjuster; supporting the goals of the Case Management department, and of CorVel. This is a remote position. ESSENTIAL FUNCTIONS AND RESPONSIBILITIES: Provides medical case management to individuals...

CorVel is seeking a full time Case Management Coordinator. The Case Management Coordinator provides staff support services to facilitate quality individualized treatment goals, including timely return-to-work, if appropriate; supporting the goals of the Case Management department, and of CorVel. This is a remote position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Assists medical case managers with case management duties Provides customer support services Types and proofreads reports and correspondence Transcribes correspondence/reports from dictation Organizes client files Requires regular and consistent attendance Complies with all safety rules and regulations during work hours in conjunction with the Injury and Illness Prevention Program (IIPP) Additional duties as required   KNOWLEDGE & SKILLS: Effective multi-tasking skills in a high-volume, fast-paced, team-oriented environment Excellent written and verbal communication skills...

The Utilization Review (UR) Intake Specialist provides staff support services including typing reports and correspondence, file handling and forms completion in addition to answering incoming telephone calls, supporting the goals of the Utilization Review / Case Management department, and of CorVel.  This is a remote position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Takes calls relating to precertification requests Verifies that all patient, provider and facility information entered in system is accurate and up to date Enters notes and service requests in CareMC system Communicates with stakeholders in a timely and professional manner Additional duties as assigned   KNOWLEDGE & SKILLS: Ability to handle multiple priorities in a high-volume, fast-paced, team-oriented environment Excellent written and verbal communication skills Ability to meet designated deadlines Computer proficiency and technical aptitude with the...

Overview Position Summary:   If you’re passionate about helping people restore their lives when the unexpected happens to their homes and providing the best customer experience, then our Mercury Insurance Property Claims team could be the place for you! Upon completion of the training program, ideal candidates will transition into a property claims field adjusting position traveling to loss sites that have been damaged by fire, water, weather, or other unexpected events. You may also handle some claims via virtual technology and/or collaborate with vendors.  The Property Claims Field Adjuster ll will learn apply knowledge of current Company policies, applicable regulatory standards, and procedures to investigate, evaluate and settle moderate Homeowner's property claims in a timely and efficient manner as to prevent unnecessary expense to the Company and policyholders, and provide exceptional service to our customers.   This field based role will be...