Denver Health
RN Registered Nurse, Utilization Coordinator Denver Health Medical Plan - Remote (Must be a Colorado Resident)
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Job Description
- Req#: R12555
Employer Industry: Healthcare Services
Why consider this job opportunity:
- Salary up to $108,300 per year
- Outstanding benefits including up to 27 paid days off per year and immediate retirement plan employer contribution up to 9.5%
- Free RTD EcoPass for public transportation and on-site employee fitness center
- Tuition reimbursement and assistance with education and development opportunities
- Opportunity for professional clinical advancement and shared governance
- Eligible for Public Service Loan Forgiveness (PSLF) and support navigating the PSLF program
What to Expect (Job Responsibilities):
- Perform clinical review of inpatient or outpatient service requests using clinical judgment and nationally accepted clinical guidelines
- Consult on cases with supervisors and request additional information from providers as needed
- Create correspondence to members and providers related to clinical determinations, adjusting language for layperson understanding
- Route potential denials of service/care to Medical Directors for review in a comprehensive and timely manner
- Support and collaborate with management in the implementation and management of utilization management activities
What is Required (Qualifications):
- Associate's Degree in nursing from a program that meets Colorado State Board of Nursing requirements for Registered Nurses
- 1-3 years of clinical experience in a hospital, acute care, home health/hospice, direct care, or case management
- RN-Registered Nurse license required
- Knowledge of case management and coordination of care principles in a healthcare environment
- Strong problem-solving skills and ability to communicate complex information clearly
How to Stand Out (Preferred Qualifications):
- 1-3 years of experience in care coordination, case management, or member navigation
- Medicaid and Medicare Managed Care experience
- Experience in home care/field-based case management or working with vulnerable populations
- Certification in Case Management
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