Colorado Licensed Utilization RN Case Manager

Working remotely on a call-in basis, the Colorado Licensed Utilization RN Case Manager will coordinate patient admissions and discharges, assess medical necessity for various care levels, and collaborate with multidisciplinary teams to ensure safe and effective patient care. Key responsibilities Plans and evaluates care for members, ensuring compliance with medical necessity criteria for admissions and discharges Conducts clinical reviews and prepares documentation for case presentations, notifying facilities of review decisions Coordinates interdisciplinary approaches to care continuity, including discharge planning and obtaining necessary authorizations Required qualifications Minimum two (2) years of clinical experience as an RN in an acute care setting Graduate of a board-approved RN program with at least 750 hours of supervised clinical experience Current Registered Nurse License in Colorado Basic Life Support certification Working knowledge of Milliman or Interqual clinical criteria and regulatory requirements