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 management solutions for workers' compensation, auto, health, and disability management industries, is seeking a highly skilled and experienced 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 make 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 management solutions, founded in 1987 and publicly traded on the NASDAQ stock exchange since 1991. We are a certified Great Place 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, Integrity, and Teamwork (ACE-IT!). Our company culture is built on a foundation of respect, empathy, 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 make 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 comply with all 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 related 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
Interface 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
Current 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 bill auditing experience preferred
Experience in clinical areas such as OR, ICU, CCU, ER, and orthopedics preferred
Prospective, concurrent, 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 Microsoft 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, Integrity, and Teamwork (ACE-IT!). By joining our team, you will have the opportunity to:
Make 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 develop 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 experienced 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 forward to hearing from you!
Apply Now
CorVel, a renowned leader in risk management solutions for workers' compensation, auto, health, and disability management industries, is seeking a highly skilled and experienced 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 make 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 management solutions, founded in 1987 and publicly traded on the NASDAQ stock exchange since 1991. We are a certified Great Place 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, Integrity, and Teamwork (ACE-IT!). Our company culture is built on a foundation of respect, empathy, 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 make 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 comply with all 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 related 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
Interface 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
Current 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 bill auditing experience preferred
Experience in clinical areas such as OR, ICU, CCU, ER, and orthopedics preferred
Prospective, concurrent, 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 Microsoft 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, Integrity, and Teamwork (ACE-IT!). By joining our team, you will have the opportunity to:
Make 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 develop 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 experienced 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 forward to hearing from you!
Apply Now