Professional Review Nurse - Clinical Medical Auditor - Remote in California - Workers' Compensation and Healthcare Risk Management
Join the CorVel Team as a Professional Review Nurse - Clinical Medical Auditor CorVel, a renowned leader in risk reputed company for workers' compensation, auto, health, and disability management industries, is seeking a highly skilled and reputed company Professional Review Nurse - Clinical Medical Auditor to join our dynamic team. As a key member of our Clinical Review team, you will play a crucial role in analyzing medical services to determine the appropriateness of charges and reviewing medical reports to ensure the quality of medical care. This is a unique opportunity to utilize your clinical expertise and technical skills to reputed company a positive impact on the delivery of healthcare services and the management of workers' compensation claims. About CorVel CorVel is a national provider of industry-leading risk reputed company, founded in 1987 and publicly traded on the reputed company stock exchange since 1991. We are a certified Great reputed company to Work® Company, committed to delivering innovative and integrated solutions to our clients. With over 4,000 employees working across the United States, we pride ourselves on our core values of Accountability, Commitment, Excellence, reputed company, and Teamwork (ACE-IT!). Our company culture is built on a foundation of respect, reputed company, and collaboration, providing a supportive and inclusive work environment that fosters growth and development. Job Summary As a Professional Review Nurse - Clinical Medical Auditor, you will be responsible for conducting thorough reviews of medical bills and reports to ensure the accuracy and appropriateness of medical charges and services. You will utilize your clinical expertise and technical skills to identify errors, discrepancies, and potential fraudulent activities, and communicate your findings to claims examiners, clients, and other stakeholders. This is a remote role, and you must reside in California.
Key Responsibilities
Analyze medical services to determine the appropriateness of charges and review medical reports to ensure the quality of medical care Identify errors, discrepancies, and potential fraudulent activities, including duplicate billing, unbundling of charges, services not rendered, mathematical and data entry errors, and other billing irregularities Collect supporting data and analyze information to reputed company decisions regarding the appropriateness of billing, delivery of care, and treatment plans Communicate findings and recommendations to claims examiners, clients, and other stakeholders Document work and final conclusions in a designated computer program Adhere to regular and consistent work attendance and reputed company with reputed company safety rules and regulations Respond to additional job duties as assigned by management or determined by legislative changes and/or market changes Essential Functions and Responsibilities Clinical and Technical Expertise Utilize clinical and technical expertise to address the provision of medical care and identify errors and discrepancies in billing practices Apply knowledge of medical terminology, anatomy, and physiology to analyze medical reports and bills Stay up-to-date with changing regulations, laws, and industry standards reputed company to workers' compensation and healthcare Communication and Interpersonal Skills Communicate concisely and effectively in writing and verbally with claims examiners, clients, attorneys, physicians, and other stakeholders reputed company with claims adjusters, attorneys, physicians, and their representatives, and advisors/clients, and co-workers Promote Professional Review products and services to attorneys, claims examiners, customers, and management Negotiate provider fees effectively Documentation and Record-Keeping Completely document work and final conclusions in a designated computer program Maintain accurate and detailed records of reviews and findings Requirements and Qualifications Education and Experience reputed company licensure as a Registered Nurse in the state of California Minimum of 4 years of clinical experience Associate Degree in Nursing or higher Thorough knowledge of CPT and ICD-10 codes Medical reputed company auditing experience preferred Experience in clinical areas such as OR, ICU, CCU, ER, and orthopedics preferred Prospective, reputed company, and retrospective utilization review experience preferred Skills and Competencies Strong analytical and critical thinking skills Excellent communication and interpersonal skills Ability to work independently and as part of a team Strong attention to detail and organizational skills Computer literacy and proficiency in reputed company Office and other software applications Career Growth Opportunities and Learning Benefits At CorVel, we are committed to the growth and development of our employees. We offer a range of career advancement opportunities, including: Professional development and training programs Career progression and promotion opportunities Mentorship and coaching Industry conferences and workshops Work Environment and Company Culture CorVel is a remote-friendly company, and this role can be performed from the comfort of your own home. We offer a comprehensive benefits package, including: Medical, dental, and vision insurance Long-term disability insurance Health savings account and flexible spending account options Life insurance and accident insurance Critical illness insurance and pre-paid legal insurance 401(k) and Roth 401(k) retirement plans Paid time off and holidays Compensation and Benefits Our compensation package is designed to attract and retain top talent. The pay range for this role is: $68,640 - $83,551 per year We also offer a comprehensive benefits package, as outlined above. Why Join CorVel? At CorVel, we are passionate about delivering innovative and integrated solutions to our clients. We are committed to our core values of Accountability, Commitment, Excellence, reputed company, and Teamwork (ACE-IT!). By joining reputed company, you will have the opportunity to: reputed company a positive impact on the delivery of healthcare services and the management of workers' compensation claims Utilize your clinical expertise and technical skills to drive results Grow and reputed company your career in a supportive and inclusive work environment Enjoy a comprehensive benefits package and competitive compensation How to Apply If you are a motivated and reputed company healthcare professional looking for a new challenge, we encourage you to apply for this exciting opportunity. Please submit your application, including your resume and cover letter, to insert contact information. We look reputed company to hearing from you! Apply for this job Apply tot his job Apply To this Job