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.


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




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