Utilization Review Nurse at Health Care Organization in Denver, Colorado, United States —
- Health Care Organization
- Denver, Colorado, United States USA
- 7/6/20 2020-07-06
Job ID: 149866
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
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