Denver Health

Registered Nurse, Utilization Coordinator

Denver Health • $77K — $116K *
Denver, CO 80219In-Person
Hospitals & Medical Centers
Less than 5 years of experience
Today
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Job Overview by Ladders

Qualifications

  • Associate's Degree in Nursing and Colorado RN license required
  • 1-3 years clinical experience in hospital, acute care, or case management
  • Knowledge of case management and care coordination principles
  • Bilingual in English/Spanish preferred
  • Strong problem-solving and communication skills
  • Proficient with Microsoft Office Suite and medical management software

Responsibilities

  • Manage observation status patients to determine discharge or inpatient status
  • Conduct daily medical necessity reviews for admissions and continued stays
  • Initiate Condition Code 44 when applicable
  • Collaborate with clinical staff to enhance documentation accuracy
  • Perform proactive reviews for cases from various hospital departments
  • Document insurance certification activities timely

Benefits

  • 28 days of paid time off annually, including holidays
  • 100% paid parental leave for up to 6 weeks
  • Employer contribution to retirement plans up to 9.5%
  • Comprehensive health, dental, and vision plans
  • On-site employee fitness center and wellness programs
  • Childcare discount programs and travel perks
  • Tuition assistance and reimbursement programs
  • Professional development opportunities through the Workforce Development Center
  • Eligible for Public Service Loan Forgiveness and loan coaching
Full Job Description
We are recruiting for a mission-driven Registered Nurse, Utilization Coordinator to join our team!

Department
REVENUE INTEGRITY

Job Summary

Under general supervision, the RN Utilization Review Coordinator will facilitate the appropriate status and level of care. This includes all commercial insurance, Medicare, Medicaid and self-pay. These will be reviewed on a cadence defined in the specific workflow. All Reviews will be done to ensure compliance with all state, federal and third-party payors. They will communicate daily and as needed to the RN Care Coordinator, Clinical Social Worker and healthcare teams.

Essential Functions:
  • Status and Level of Care Management
    • Manages observation status patients to determine appropriateness for discharge or conversion to inpatient admission using approved medical necessity criteria continually throughout the observation stay
    • Conducts medical necessity reviews on all inpatient admissions, transfers and continued stay patients using approved medical necessity criteria daily
    • Initiates Condition Code 44 process when applicable
    • Works with the Clinical Documentation Improvement Specialists and physicians to identify opportunities to improve the accuracy of the documentation as well as identify the working MSDRG and associated geometric mean length of stay
    • Conducts proactive medical necessity review of cases being referred from the Emergency Room, PACU, transfers and direct admissions from physician offices to ensure appropriate status and level of care placement , as assigned
    • Uses the criteria software application to document results of criteria application according to the documentation policy, i.e. MCG criteria application, length of stay assignments and variance documentation, etc.
    • Initiates Physician Advisor referrals for any cases not meeting criteria for the level of care
    • Ensures compliance with all state, federal and payor medical necessity and certification requirements
    (40%)
  • Utilization Review for Insurance Companies
    • Documents clinical information as required for insurance company certification according to required payor timeframe standards
    • Works collaboratively with the Clerical Support Staff to ensure all insurance reviews are received by the insurance company and a disposition response is received
    • Documents all insurance certification activities in the assigned locations according to the department documentation standards
    (40%)
  • Compliance
    • Ensures compliance with all applicable state and federal regulatory requirements as well as the insurance company rules such as Patient Choice, Important Message from Medicare #2, Condition Code 44, insurance certification processes, etc.
    • Maintains compliance with established hospital policies, procedures, objectives, safety, environmental and infection control guidelines
    • Protects Patient Rights as they pertain to the ethical and legal issues of confidentiality during the case management process
    (20%)

Education:
  • Associate's Degree Completion of a nursing education program that satisfied the licensing requirements of the Colorado State Board of Nursing for Registered Nurses. Required

Work Experience:
  • 1-3 years Three years clinical experience in a hospital, acute care, home health/hospice, direct care or case management required. Required

Licenses:
  • RN-Registered Nurse - DORA - Department of Regulatory Agencies Required

Knowledge, Skills and Abilities:
  • Bilingual in English/Spanish preferred.
  • Knowledge and understanding of case management/coordination of care principles, programs, and processes in either a hospital or outpatient healthcare environment.
  • Effectively collaborate with and respond to varied personalities in differing emotional conditions, and maintain professional composure at all times. Strong customer service orientation and aptitude.
  • Problem solving skills; the ability to systematically analyze problems, draw relevant conclusions and devise appropriate courses of action.
  • Ability to communicate verbally and in writing complex or technical information in a manner that others can understand, as well as ability to understand and interpret complex information from others.
  • Microsoft Office Suite required.
  • Experience with windows-based computer programs and ability to use computer for data analysis and data display required.
  • Prefer experience with Medical Management platforms used to document care coordination services.


Shift

Work Type
Regular

Salary
$77,400.00 - $116,100.00 / yr

Benefits

At Denver Health, we take care of the people who take care of our community. Our benefits are built to support your life, your family, and your future - with generous paid time off, fully paid parental leave, exceptional retirement contributions, comprehensive health coverage, and nationally recognized well-being programs. We invest in your growth through tuition assistance, career advancement pathways, and professional development - while also offering meaningful financial advantages through loan forgiveness eligibility and employer contributions. When you join Denver Health, you're joining a mission-driven organization that invests in you.

Here is a small list of our benefit programs:
  • Paid time off starting at 28 days per year, inclusive of vacation, personal/sick, and 7 Holidays
  • 100% paid parental leave up to 6 weeks
  • Immediate eligibility for retirement plans with employer contribution up to 9.5%
  • Generous medical, dental, vision plans in addition to employer paid disability and life insurance.
  • Comprehensive well-being programs including on-site employee fitness center located on Denver Health main campus and nationally recognized RESTORE Center
  • Free RTD EcoPass (public transportation)
  • Childcare discount programs & exclusive perks on large brands, travel, and more
  • Tuition reimbursement & assistance
  • Education, coaching, and professional development opportunities through the Workforce Development Center (WFDC) that support internal career growth and advancement pathways
  • Professional clinical advancement program & shared governance
  • Public Service Loan Forgiveness (PSLF) eligible employer+ free student loan coaching and assistance navigating the PSLF program
  • National Health Service Corps (NHCS) and Colorado Health Service Corps (CHSC) eligible employer

About Denver Health

Denver Health stands as a beacon of healthcare excellence in Denver, Colorado. Denver’s comprehensive healthcare system offers an array of high-paying jobs and rewarding career opportunities. This integrated network, encompassing a premier hospital, a series of community health centers, and a robust public health department, serves as the city's primary safety net institution. As a Level One Trauma Center with specialized pediatric and neonatal intensive care units, Denver Health is not only pivotal in providing critical care but also plays a significant role in medical education, being affiliated with the University of Colorado School of Medicine.

Overview of Denver Health Careers

A Diverse Range of Healthcare Roles

Denver Health careers span a wide spectrum, from clinical roles in nursing and specialized medicine to administrative and support positions. As a teaching hospital, it offers a unique environment for professional growth, blending patient care with educational opportunities.

Available Job Opportunities

High-Demand Positions

Among the highest paying and most sought-after positions at Denver Health are Psychologist, Psychiatrist, and Licensed Therapist roles. This reflects the system's comprehensive approach to mental health services alongside its medical offerings.

Nursing and Clinical Staff

Opportunities in nursing and other clinical areas offer the chance to work directly with a diverse patient population. And of course, nursing and clinical staff are supported by state-of-the-art facilities and a network of community clinics.

Administrative and Support Roles

From medical billing specialists to healthcare administrators, Denver Health provides a variety of non-clinical positions essential to the smooth operation of the healthcare system.

Qualifications and Requirements

Ensuring the Highest Standards of Care

Denver Health seeks healthcare professionals who possess the necessary skills and experience and are committed to excellence in patient care and continuous learning.

Education and Certification

For clinical positions, specific degrees, certifications, and licenses are required, reflecting the level of expertise and specialization needed to meet the healthcare needs of the Denver community.

Application Process

Steps to Joining Denver Health

The journey to a career at Denver Health begins with a straightforward application process designed to identify candidates who align with the system's values and standards of care.

Submitting Your Application

Candidates can apply through Denver Health's online job portal, where current vacancies are listed. A detailed resume and cover letter tailored to the specific position are crucial components of the application.

Interview Tips and Techniques

Standing Out as a Candidate

Succeeding in the interview requires preparation and an understanding of what Denver Health values in its staff—a dedication to patient care, teamwork, and professional integrity.

Demonstrating Your Fit

Be ready to discuss how your skills, experience, and values align with the mission of Denver Health. Prepare examples from your past work that showcase your ability to contribute positively to the healthcare system.

Training and Development Programs

Commitment to Continuous Professional Growth

Denver Health offers extensive training and development programs, supporting its staff in achieving their highest potential and ensuring the delivery of top-quality care.

Advancing Your Skills

From on-the-job training to formal education programs, employees have opportunities to enhance their clinical skills, leadership abilities, and overall knowledge of healthcare practices.

Benefits and Compensation Packages

Rewarding Your Contribution

Denver Health offers competitive benefits and compensation packages, acknowledging the hard work and dedication of its employees with rewards that reflect their value to the healthcare system.

Comprehensive Benefits

Employees enjoy a range of benefits, including health insurance, retirement plans, and paid time off, alongside opportunities for bonuses and salary advancements based on performance and experience.

Employee Testimonials and Success Stories

From Our Staff to You

Hearing directly from Denver Health employees provides insight into the supportive work environment, career advancement opportunities, and the personal satisfaction derived from making a difference in the lives of patients.

Making an Impact

Employee stories highlight the rewarding nature of work at Denver Health, where every staff member plays a critical role in providing care and improving community health.

Career Advancement Opportunities

Pathways to Professional Development

Denver Health is committed to the career advancement of its employees, offering various pathways for professional development, from leadership roles within the nursing staff to specialized medical positions and administrative leadership.

Contacts and Resources for Further Information

Navigating Your Denver Health Career Path

For more detailed information about careers, the application process, or specific job openings at Denver Health, prospective applicants are encouraged to utilize the following resources:

Denver Health Careers Page

The primary resource for current job listings, application guidelines, and comprehensive information about working at Denver Health.

Further Assistance

For specific questions not addressed on the website, potential applicants can contact Denver Health's HR department directly through the provided contact details on the careers page.
Learn more about Denver Health
Size
7,000 employees
Industry
Healthcare
Founded
1860
* Ladders Estimates

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