Available Positions

Utilization Review Nurse at Health Care Organization in Denver, Colorado, United States —

  • Healthcare
  • Health Care Organization
  • Denver, Colorado, United States
  • 7/6/20

Job ID: 149866

Job Description

We are actively seeking multiple Utilization Review Nurse RN to join our team in Denver, CO ASAP! We are a national healthcare organization with several locations throughout the states!

If you’re interested in hearing more, please apply today!

 

Daily Responsibilities for Utilization Review Nurse RN:

  • Complete medical necessity and level of care reviews for requested services using clinical judgment and refer to Medical Directors for review depending on case findings
  • Identify placement settings that offer the lowest level of restriction and greatest level of autonomy for the members based upon medical necessity.
  • Monitor quality of care and collect and analyze utilization data
  • Serve as a resource and liaison between the health plan, behavioral providers, facilities, member and families
  • Provide and review member intakes and initial evaluations
  • Comply with performance measures in regards to denials, higher level of care admission certifications and concurrent review timeliness
  • Develop and maintain collaborative relationships with providers and educate on levels of care
  • Interact with physicians, social workers, providers, case managers, and internal staff to develop discharge plans and oversee their implementation
  • Authorize and/or review utilization of mental health and substance abuse services provided in inpatient and intermediate care settings. Assure appropriate levels of care and medical necessity in a manner that supports the recovery process

Hours for Utilization Review Nurse RN:

Monday – Friday Standard Business Hours

 

Advantages of this Opportunity:

· Salary is 65k - negotiable with experience

Full medical benefits offered

Next Steps:

If you’re interested in speaking in more detail, please apply today! We are scheduling interviews ASAP.

Qualifications

Requirements for Utilization Review Nurse RN:

• 3 years of exp working in utilization mngt department (UR, UM, Discharge Planning, CM, Retrospective Review, Concurrent Review)

• Must have BSN

• Must be RN with clear/active license

• Background working with Medicare and Medicaid population

 

*MO25

Apply

Explore your Recruiting Career

Discover the wide range of opportunities Green Key has to offer.

Learn More

Join Our Network

You’ve worked hard for your industry experience. Now put that experience to work.

Send us your resume

Green Key Blog

News for the way you work.

More from the blog