Utilization Management Registered Nurse

You Matter

• Make a difference every day in the lives of the underserved• Join a mission driven organization with a people first culture• Excellent career growth opportunities

Join us and find a career that supports:• Caring for overlooked, underserved, and vulnerable patients• Diversity, equity, inclusion, and belonging• Autonomy in a warm team environment• Growth and training

Perks and Benefits In addition to comprehensive benefits including medical, dental, vision, paid time off, and 401k, we foster a work, life balance for team members and their family to support physical, mental, and financial wellbeing including: • DailyPay, receive your money as you earn it! • Tuition Assistance and dependent Scholarships• Employee Assistance Program (EAP) including free counseling and health coaching• Company paid life insurance• Tax free Health Spending Accounts (HSA)• Wellness program featuring fitness memberships and product discounts• Preferred banking partnership and discounted rates for home and auto loans

*Eligibility for perks and benefits varies based on employee type and length of service. 

Why Us

Now is your moment to make a difference in the lives of the underserved.

If there is one unifying characteristic of everyone on our team, it is the deep desire to make a difference by helping society's most vulnerable and often overlooked individuals. Every day we have the distinct honor and responsibility to show up with non-judgmental compassion to provide hope and healing to those who need it most. For those whose calling it is to serve others, now is your moment to join our mission to provide quality care to every patient with compassion, collaboration, and innovation, to live our mantra to “Always Do The Right Thing!”, and to collectively do our part to heal the world, one patient at a time.

Wellpath sees hundreds of thousands of unique individuals in their facilities month over month and a very large percent of those individuals receive direct clinical care, which includes lives saved by Narcan. 

We offer ongoing training and development opportunities for licensed and unlicensed healthcare team members, and have best in class clinical resources for training, education, and point of care support.

How you make a difference

The Utilization Management Registered Nurse works under the guidance of the Utilization Provider to oversee the coordination of clinical care daily. This role involves conducting utilization management tasks, offering support, and engaging in care management activities, ensuring adherence to nursing standards and regulatory requirements at both state and federal levels.

Key Responsibilities

• Perform comprehensive clinical reviews of off-site observation, outpatient, and acute care using InterQual Criteria, ensuring adherence to department procedures.• Review concurrent clinical information and document it in the ERMA Care Management System, following department guidelines, including appropriate claims holds and compliance with Medical Review procedures.• Evaluate pre-certification referrals for outpatient visits, office procedures, surgical procedures, imaging, and specialty services, in accordance with department procedures for Urgent, Scheduled, and Routine cases.• Collaborate with Regional Medical Directors, Site Medical Directors, Providers, and Operations personnel for effective care coordination and facilitate routine reviews of utilization data in the ERMA Care Management system to ensure accuracy and timeliness.• Communicate and collaborate with various hospital departments, including billing, utilization management, and medical records, establishing rapport and effectively managing medical costs through accurate coding, data entry, and referral approval.

Qualifications & Requirements

Education

• Unrestricted, current RN license in state of employment
• BSN, CCM preferred.

Experience

• Two (2) years’ clinical experience with Utilization Management experience
• Previous correctional/detention facility experience

Licenses/Certifications

• Must maintain all certifications, educational requirements, licensing, etc. for RN license

We are an Equal Employment Opportunity Employer

We are committed to fostering, cultivating, and preserving a culture of uniqueness.

We celebrate a variety of backgrounds and are committed to creating an inclusive environment for all employees.

We encourage you to apply! If you are excited about a role but your experience doesn’t seem to align perfectly with every element of the job description, we encourage you to apply. You may be just the right candidate for this, or one of our many other roles.

Deadline to apply to this position is contingent upon applicant volume. Those positions located in Colorado will have a specific deadline posted in the job description.

We are an Affirmative Action Employer in accordance with applicable state and local laws.