Senior RN: Utilization Management for Health Plans

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

Job summary

A leading staffing firm is seeking 2 full-time RN Case Managers to join their Managed Care department in Denver. The role involves medical utilization management, ensuring compliance with regulatory requirements, and requires a BSN and three years of relevant experience. Ideal candidates will have hands-on experience with InterQual and MCG guidelines.

Qualifications

• BSN required with a combination of education and experience acceptable.
• Typically 3 years of medical utilization management experience.
• Experience with Managed Care and health insurance plans preferred.

Responsibilities

• Provides medical and/or behavioral health utilization management for members in accordance with plan benefits.
• Completes clinical reviews using recognized criteria.
• Coordinates with the Medical Director for additional review if needed.

Skills

Utilization Management

InterQual

MCG

Communication

Education

Bachelor’s degree in Nursing

Job description

A leading staffing firm is seeking 2 full-time RN Case Managers to join their Managed Care department in Denver. The role involves medical utilization management, ensuring compliance with regulatory requirements, and requires a BSN and three years of relevant experience. Ideal candidates will have hands-on experience with InterQual and MCG guidelines.