Denver Health RN Case Manager MC (Intensive) in Denver, Colorado
Job Summary Under minimal supervision, provide utilization management for members of a Managed Care Organization. Utilizes national standardized criteria such as InterQual or MCG to review requests for service to determine if a request can be approved, or if the request requires Medical Director Review
Minimum Qualifications Education: Bachelor of Science in Nursing. A combination of education and experience may be substituted for the BSN requirement.
Experience: Typically, 3 years clinical experience (medical/surgical, home health, etc). Utilization Management experience preferred. Experience with clinical criteria for utilization managment. Managed Care experience preferred.
Knowledge, Skills & Abilities: Knowledge of major concepts, principles and theories related to nursing process. Working knowledge of adult and/or pediatric health issues. Knowledge of the special health care needs of the Medicaid/Medicare population. Basic knowledge of managed care and case management principles. Skilled in critical assessment, analysis, and problem solving -- able to to find workable solutions to complex problems. Excellent time management and critical thinking skills. Strong written and verbal communication skills - to include effective telephonic communication. Ability to work well with all types of providers/customers. Ability to work autonomously and in a team environment. Ability to establish and maintain rapport and therapeutic relationships with individuals, families, groups, and communities. Uses computers, including Microsoft Outlook Word, PowerPoint, and Excel. Bilingual English/Spanish or English/other languages preferred.
Certificate/License/Registration: Colorado (or compact state) RN license in good standing. Case Management Certification (CCM) preferred. All Certifications and Licenses required for this job must be kept current as a condition of continued employment.
Denver Health is an integrated, efficient, high-quality academic health care system that is considered a model for the nation. The Denver Health system includes the Rocky Mountain Regional Level I Trauma Center, a 525-bed acute care medical center, Denver’s 911 emergency medical response system, 8 family health centers, 15 school-based health centers, the Rocky Mountain Poison and Drug Center, the Denver Public Health Department, an HMO, and The Denver Health Foundation.
As Colorado’s primary safety net institution, Denver Health is a mission-driven organization that has provided more than $3.3 billion in care for the uninsured in the last ten years. Denver Health is a leader in performance and quality improvements and remains financially secure, in part, due to its nationally recognized implementation of lean principles in healthcare. Denver Health is a major resource to the community, serving approximately 185,000 individuals and 67,000 children a year.
Located just south of 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 is committed to provide equal treatment and equal employment opportunities to all applicants and employees. Denver Health is an Equal Opportunity Employer and does not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class. Facility: Managed Care, 938 Bannock St.
Area of Interest: Managed Care
Shift Type: Varies
Requisition ID: 48148
Employment Type: Full-Time
Experience Required: 3 - 5 Years
Education Required: Bachelors Degree
Certification/Licensure/Registrations Required: CO RN License