Utilization Review Coordinator/Nurse (RN or LPN)

Utilization Review Coordinator/Nurse (RN or LPN)

CoreCare Management Services LLC
Mandeville, LA
Full-Time, Part-Time, and Per Diem / PRN Opportunities Available

Job Summary

CoreCare Management is seeking an experienced and detail-oriented nurse to join our Utilization Review Care team. This position is responsible for reviewing medical treatment requests related to workers’ compensation claims to ensure compliance with Louisiana Office of Workers’ Compensation Medical Treatment Guidelines.

The ideal candidate will possess strong clinical judgment, excellent organizational skills, and the ability to work independently in a fast-paced environment. Experience in workers’ compensation, utilization review, case management, or managed care is strongly preferred.

Essential Duties & Responsibilities

• Review proposed medical interventions and treatment requests (1010 submissions) for appropriateness and guideline compliance
• Receive, review, and complete all 1010 submissions within required timeframes
• Amend 1010 submissions when necessary based on medical treatment guidelines
• Respond to 1009 disputes and assist adjusters with documentation and claim-related questions
• Coordinate State IME and SMO services as needed
• Complete Medicare Set-Asides (MSAs) accurately and efficiently
• Assist with Medical Cost Projections related to future medical expenses
• Review medical records and supporting documentation to determine future treatment needs
• Maintain accurate and timely documentation
• Communicate professionally with providers, adjusters, clients, and team members
• Ensure compliance with HIPAA and confidentiality standards

Qualifications

• Active RN or LPN license required
• RN strongly preferred
• Compact nursing license preferred or willingness to obtain within 6 weeks of hire
• Nursing degree required
• CCM certification preferred but not required
• 3 years of nursing experience preferred
• Prior experience in workers’ compensation, utilization review, case management, or managed care strongly preferred
• Knowledge of Louisiana Workers’ Compensation Medical Treatment Guidelines preferred
• Strong analytical, organizational, and critical thinking skills
• Excellent written and verbal communication skills
• Ability to prioritize multiple tasks and meet deadlines
• Ability to work independently and collaboratively within a team environment
• Proficient computer and documentation skills

Compensation & Benefits

• Competitive compensation based on experience and employment status
• Full-Time, Part-Time, and Per Diem / PRN opportunities available
• Health insurance
• Dental insurance
• Vision insurance
• 401(k)
• Supplemental insurance options
• Paid vacation
• Monthly office equipment/phone allowance

Schedule

• Monday to Friday
• Day shift

Work Location

• Mandeville, LA
• Remote/Hybrid consideration available for qualified candidates

About CoreCare Management

CoreCare Management provides comprehensive workers’ compensation medical management services focused on ensuring injured workers receive appropriate, timely, and guideline-compliant care.

Our services include Field Case Management, Telephonic Case Management, Vocational Rehabilitation, Catastrophic Case Management, Utilization Review, Medicare Set-Asides (MSAs), Life Care Planning, Medical Cost Projections, and Bill Review services.

Our experienced team works closely with injured workers, healthcare providers, employers, attorneys, adjusters, and rehabilitation professionals to coordinate care, facilitate communication, and support positive claim outcomes.

We are committed to professionalism, efficiency, compassionate care coordination, and delivering high-quality support to our clients throughout every stage of the recovery process.

Please send resumes to Referrals@corecare.us

CoreCare Management Services LLC is an Equal Opportunity Employer. We are committed to creating an inclusive workplace and do not discriminate on the basis of race, color, religion, sex, pregnancy, sexual orientation, gender identity, national origin, age, disability, genetic information, veteran status, or any other protected status under applicable federal or state law.

Benefits:

• 401(k)
• Dental insurance
• Health insurance
• Paid time off
• Vision insurance

Work Location: Hybrid remote in Mandeville, LA 70448