RN- MANAGED CARE ADMINISTRATION

Integrated Resources Inc.; Denver (CO); On-site; USD 70,000 - 90,000; Full time

Job summary

A renowned healthcare facility in Denver is seeking two full-time RN Case Managers for their Managed Care department. Candidates must possess a Bachelor of Science in Nursing (BSN) and have a minimum of three years of experience in medical utilization management. Preferred qualifications include experience with InterQual and MCG, to ensure adherence to the defined schedule of benefits and network criteria for the facility's medical plan.

Qualifications

• Minimum 3 years' experience in medical utilization management.
• Experience with health insurance plans is essential.
• Managed Care and hospital experience are both considered.

Responsibilities

• Provides medical and behavioral health utilization management for members.
• Works in accordance with the schedule of benefits and network criteria defined by various lines of business.

Skills

Medical utilization management

InterQual

MCG

Education

Bachelor of Science in Nursing (BSN)

Job description

• The facility in Denver seeks 2 F/T RN Case Managers for excellent contract working in Managed Care department.
• Must have BSN, 3 years' experience in medical utilization management, and experience working with a health insurance plan.
• Managed Care experience is preferred however hospital experience is also considered.
• Seeking highly skilled individual with experience with InterQUal and MCG.
• Provides medical and/or behavioral health utilization management for members of facility medical plan in accordance with the schedule of benefits and network criteria defined by the Plans various lines of business and Center for Medicare & Medicaid Services.

Additional Information

TITLE: RN - MANAGED CARE ADMINISTRATION.