We are recruiting for a RN Utilization Coordinator, Denver Health Medical Plan to join our team!
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Department
Managed Care Administration*Remote Opportunity. Must Be a Colorado Resident
Job Summary
Under minimal supervision the RN, Utilization Coordinator uses critical clinical thinking skills to perform initial inpatient or outpatient utilization review activities to determine the efficiency, effectiveness and quality of medical and behavioral health services. The RN, Utilization Coordinator, in collaboration with the UM Supervisor, serves as liaison between ordering and service providers and the Health Plan. This position makes 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 to contract and policy guidelines. Position prepares letters to providers and members to convey approval or denial of requested services, identifies and reports on specific cases, and provides information regarding utilization management requirements and operational procedures to members, providers and facilities. Position communicates with the Medical Director regarding clinical questions and decision-making.
Essential Functions:
Education:
Work Experience:
Licenses:
Knowledge, Skills and Abilities:
Shift
Work Type
RegularSalary
$76, - $115, / yrBenefits
Competitive pay
Outstanding benefits
Education opportunities
Shared leadership and advancement opportunity
State-of-the-art facilities
Immediate retirement plan matching
Professional clinical advancement program
Participation in evidence-based projects
Public Service Loan Forgiveness (PSLF) eligible employer
National Health Service Corps (NHCS) and Colorado Health Service Corps (CHSC) eligible employer
Our Values
Respect
Belonging
Accountability
Transparency
All job applicants for safety-sensitive positions must pass a pre-employment drug test, once a conditional offer of employment has been made.
Denver Health is an integrated, high-quality academic health care system considered a model for the nation that includes a Level I Trauma Center, a 555-bed acute care medical center, Denver’s 911 emergency medical response system, 10 family health centers, 19 school-based health centers, Rocky Mountain Poison & Drug Safety, a Public Health Institute, an HMO and The Denver Health Foundation.
As Colorado’s primary, and essential, safety-net institution, Denver Health is a mission-driven organization that has provided billions in uncompensated care for the uninsured. Denver Health is viewed as an Anchor Institution for the community, focusing on hiring and purchasing locally as applicable, serving as a pillar for community needs, and caring for more than 185,000 individuals and 67,000 children a year.
Located near downtown Denver, Denver Health is just minutes away from many of the cultural and recreational activities Denver has to offer.
We strongly support diversity in the workforce and Denver Health is an equal opportunity employer (EOE).
Denver Health values the unique ideas, talents and contributions reflective of the needs of our community. For read more about our commitment to diversity visit: