Job Description

CorVel is seeking a Quality Assurance Nurse with experience in worker's compensation to conduct utilization review and case management quality assurance audits.

ESSENTIAL FUNCTIONS & RESPONSIBILITIES:

• Develop, implement and provide ongoing quality assurance calibration of processes both managed and delivered at the operational level.
• Educate and equip operations with performance measurement and reporting tools that can be used to objectively measure and grow operations.
• Provide national account and regulatory quality oversight.
• As applicable, provide oversight and management of URAC compliance and renewals.
• Interface with utilization review managers regarding compliance with organizational policies and procedures and URAC standards.
• Serve as provider/client/vendor resource for utilization review.
• Work with case management and utilization review department management to address CorVel standards inclusive of quality assurance, reporting and processes.
• Develop, run and interpret management reports to ensure case management and utilization review operations are utilizing the tools available to manage compliance of services delivery within company standards.
• Facilitate peer-to-peer quality reviews to ensure delivery of quality case management and utilization review.
• Review results and outcomes with general management and case management leadership.
• Make recommendations in collaboration with field operations to ensure actions toward improvement are identified.
• Implementation, oversight and communication of regulatory requirements within case management services to include, state, federal and URAC.
• Direct quality assurance audit activities and quality improvement plans in coordination with utilization management team managers, to ensure compliance with both state and URAC requirements.
• Conducts various types of case reviews for quality and appropriate medical management, cost containment, peer review and rehabilitation.
• Identify trends and recommend action plans to management for continuous process improvement.
• Performs other duties as assigned.

KNOWLEDGE & SKILLS:

• Excellent oral and written communication skills.
• PC literate, including Microsoft Office (Word, Excel).
• Strong knowledge of the clinical and case management processes.
• Knowledge of regulatory and accreditation agencies and requirements.
• Strong knowledge and experience in quality assurance and training programs.
• Proficient in identifying case management office improvement opportunities and communicating and implementing solutions.
• Ability to develop routine reports and correspondence and to present information in one-on-one, small group and large group settings.
• Ability to remain poised in stressful situations and communicate diplomatically via telephone, computer, fax, correspondence, etc.
• Ability to skillfully manage multiple, complex projects and competing priorities concurrently while working under pressure to meet deadlines and maintaining strong customer service orientation.
• Effective quantitative and analytical skills.
• Must have strong organizational skills.
• Ability to work independently or in a team environment while functioning as an educator rather than an auditor.
• Knowledge of the entire claims administration, case management and cost containment solution as applicable to third party administrator operations.

EDUCATION & EXPERIENCE:

• Graduate of accredited school of nursing with a diploma/Associate degree (Bachelor of Science degree or Bachelor of Science in Nursing preferred)
• 3 or more years of recent clinical experience, preferably in rehabilitation.
• National certification (CRC, CIRS, CCRN, CVE, CCM, etc.), CCM preferred.
• Four-year degree at an accredited college or university preferred.
• Certified Trainer and/or Quality Assurance distinction, a plus.

• 4 years of utilization management experience; OR
• Equivalent combination of training, education, and experience.
• Preferred experience: The ideal candidate will have prior experience interacting with regulatory agency contacts, writing policies and procedures for URAC compliance, authoring state utilization review certification applications and renewals, and have familiarity with legal and regulatory research related to workers' compensation utilization management laws, regulations, rules and URAC standards interpretation.

• Prior quality assurance, utilization review and/or training a plus.
• Current RN licensure.

PAY RANGE:

CorVel 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: $56,860 – $91,580

A list of our benefit offerings can be found on our CorVel website: CorVel Careers | Opportunities in Risk Management

ABOUT CORVEL:

CorVel, a certified Great Place to Work® Company, is a national provider of industry-leading risk management solutions for the workers' compensation, auto, health and disability management industries. CorVel was founded in 1987 and has been publicly traded on the NASDAQ stock exchange since 1991. Our continual investment in human capital and technology enable us to deliver the most innovative and integrated solutions to our clients. We are a stable and growing company with a strong, supportive culture and plenty of career advancement opportunities. Over 4,000 people working across the United States embrace our core values of Accountability, Commitment, Excellence, Integrity and Teamwork (ACE-IT!).

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.

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

Together, let’s do more.

We are a national provider of risk management solutions for the workers’ compensation, auto, health and disability management industries. We provide our clients with the information and insight they need to make smart decisions. We believe that together, we can deliver better results.

Innovation is our passion.

We invest in intelligent systems and the integrated ecosystem that keeps us all connected. Our commitment to innovation is why we are a nationwide leader in technology driven programs.

We strive for excellence.

With the right mix of savings and customer service, we effectively balance risk and reward. Our expertise and service delivery drive the results your program needs and the savings your bottom line wants.

Our purpose is care.

Every injured worker needs timely, compassionate care. We value your people and we advocate care for your employees. This purpose drives what we do together every day, which is to return injured employees to the workplace.

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