Colorado Licensed Utilization Case Manager

Job Summary

Working remotely on a call-in basis, the Colorado Licensed Utilization Case Manager will coordinate admissions and discharge planning, assess medical necessity for inpatient care, and collaborate with multidisciplinary teams to ensure quality patient management.

Key responsibilities:

• Evaluate and authorize the medical necessity of inpatient and skilled nursing admissions while ensuring compliance with regulatory requirements
• Develop and implement discharge plans in collaboration with patients, families, and care teams to facilitate safe transitions of care
• Conduct clinical reviews and participate in care planning rounds, documenting all necessary information in medical management systems

Required qualifications:

• Minimum two (2) years of clinical experience as a Registered Nurse in an acute care setting
• Graduate of a board-approved RN program with at least 750 hours of clinical experience
• Current Colorado Registered Nurse License and Basic Life Support certification
• Knowledge of Utilization review/management principles and regulatory standards
• Computer literacy and ability to utilize clinical criteria such as Milliman or Interqual