Colorado Licensed RN Care Manager

Job Summary

To support efficient healthcare delivery, the part-time Colorado Licensed RN Care Manager will perform utilization review care management screenings, assessments, and evaluations remotely while collaborating with patients, providers, and insurers to ensure high-quality, cost-effective care.

Key responsibilities

• Conducts reviews and investigations of medical records to ensure appropriate benefit utilization and medical necessity
• Applies evidence-based guidelines and regulatory standards for prior authorization and post-service reviews
• Engages proactively with healthcare providers and members to facilitate safe transitions of care and expedite authorization processes

Required qualifications

• Current Registered Nurse (RN) license in the state of practice, with compact licensure
• Bachelor of Science in Nursing (BSN) from an accredited institution, or must obtain within four years of hire
• Experience in care management or a closely related field, including Utilization Management or discharge planning
• Clinical nursing experience in an inpatient hospital setting
• Understanding of disease management and the ability to identify barriers to care delivery