REMOTE RN - Utilization Service Coordinator

Medix is looking to hire a FULLY REMOTE UM RN - Utilization Service Coordinator to join a private non-profit healthcare maintenance organization based in Denver, CO. Under the supervision of the Supervisor of Behavioral Health Utilization Management, the Utilization Service Coordinator is responsible for all components of Utilization Review for the organization. Identifies members through the review process that are eligible for intensive case management. Makes referrals as appropriate to community resources and agencies. Works in collaboration with other teams within the Coordinated Clinical Services department to facilitate efficient administration of departmental policies and procedures. Responsible for applying criteria and/or guidelines specific to authorization reviews.

Responsibilities:

• Responsible for all aspects (i.e. documentation, authorization letters, etc.) regarding authorizations, utilization management and coordination of inpatient acute care, sub-acute, outpatient care, rehabilitation services, and home health care for consumers accessing physical health and/or behavioral health benefits.
• Facilitates and coordinates discharge planning and works towards reduction of preventable hospital admissions, re-admissions, excessive therapies, DME, etc.
• Interfaces with network providers regarding consumer service plans and care coordination.
• Works closely with the Supervisor of Behavioral Health Utilization Management to identify and solve problems related to providers, provider networks, access to and availability of services.
• Supports quality improvement activities. Reports potential quality issues and concerns to the Medical Director and the Quality Management department.
• Performs telephonic concurrent reviews of inpatient and outpatient episodes of care.
• Understands, communicates and facilitates on behalf of the consumer, providers and other ancillary suppliers the complaint, grievance and appeal processes. Advises on the existing resources such as "Member's Handbook" and "Provider Manual".

Requirements / Experience

• 1+ years of UM experience in Behavioral Health space
• SUD Experience (highly preferred)
• Must possess an active and current CO state or Compact RN license

Schedule:

• Monday- Friday 8:00- 5:00 pm (MST)

Pay range:

• $40-47/hr BOE

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