RN- MANAGED CARE ADMINISTRATION
On-site · Denver, Colorado, United States
Job Summary
Provide medical and/or behavioral health utilization management for members of the 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. Responsibilities include working in Managed Care to assess utilization needs, applying criteria (InterQual and MCG), and coordinating care according to plan benefits. Requires BSN and 3 years' utilization-management experience, with preference for Managed Care experience; hospital experience may be considered. Located in Denver, CO on a 3+ month, full-time contract basis.
Required Qualifications
- BSN
- 3 years' experience in medical utilization management
- experience working with a health insurance plan
- Managed Care experience is preferred
- experience with InterQual and MCG
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