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RN Utilization Review Coordinator
2 months ago
Denver Health is seeking a skilled RN Utilization Review Coordinator to join our team. As a key member of our Managed Care Administration department, you will play a critical role in ensuring the efficient and effective delivery of medical and behavioral health services.
Key Responsibilities:- Perform initial inpatient or outpatient utilization review activities to determine the efficiency, effectiveness, and quality of medical and behavioral health services.
- Collaborate with the UM Supervisor to serve as a liaison between ordering and service providers and the Health Plan.
- Make medical determination decisions within defined protocols based on review of the service requests, clinical and non-clinical data, Member eligibility, and benefit levels in accordance with contract and policy guidelines.
- Convey approval or denial of requested services, identify and report on specific cases, and provide information regarding utilization management requirements and operational procedures to members, providers, and facilities.
- Associate's Degree in Nursing or equivalent required.
- 1-3 years of clinical experience in a hospital, acute care, home health/hospice, direct care, or case management required.
- Medicaid and Medicare Managed Care experience preferred.
- Home care/field-based case management or working with vulnerable populations with chronic medical, behavioral health, or social needs preferred.
- Certification in Case Management preferred.
- Competitive salary and benefits package.
- Opportunities for professional growth and development.
- A dynamic and supportive work environment.
- Recognition and rewards for outstanding performance.
Denver Health is an integrated, high-quality academic health care system considered a model for the nation. We are a mission-driven organization that provides billions in uncompensated care for the uninsured. We value diversity and are an equal opportunity employer.
