Utilization Service Coordinator - Pro Re Nada (after hours)

The vision of Colorado Access is to have healthy communities transformed by the care that people want at a cost we can all afford. Our mission is to partner with communities and empower people through access to quality, affordable care.

Why should you consider a career with Colorado Access?

We are a Colorado-based company, working to improve the health of our state. We care for individuals, families, and children who receive health care under Child Health Plan Plus (CHP+) and Health First Colorado (Colorado's Medicaid Program). Our focus is driving improvements in quality, member experience, outcomes, and cost. We are a mission-driven organization whose foundation is built by our vision, supported by our values and pillared by diversity, equity and inclusion.

Be a part of something bigger and make an impact: We serve the underserved and most vulnerable populations in our community through access to quality and affordable health care. No matter what you do for Colorado Access, you are impacting our community and making a difference.

What you will do:

We are looking for a

Pro Re Nata (PRN) Utilization Service Coordinator

like you who can help shape our vision and support our mission in after hours support. Pro Re Nada is part time, as needed.

This position will require after hours shift coverage,

covering alternating weeks: every other Tuesday/Wednesday 8pm MST - 2am MST

and then

Saturday/Sunday 8pm MST-2am MST.

Here is what the day-to-day functions will look like:
Responsible for all aspects (i.e. documentation, authorization letters, etc.) regarding authorizations, utilization management and coordination of inpatient acute care, sub-acute, outpatient care, rehabilitation services, and home health care for consumers accessing physical health and/or behavioral health benefits. Facilitates and coordinates discharge planning and works towards reduction of preventable hospital admissions, re-admissions, excessive therapies, DME, etc
Performs telephonic reviews of inpatient and outpatient episodes of care. Gathers pertinent clinical information and applies/interprets criteria to ensure medical necessity, covered benefits, participating providers and appropriate services. Refers cases not meeting approved criteria/guidelines to the Medical Director for determination.
Works closely with the Supervisor of Behavioral Health Utilization Management to identify and solve problems related to providers, provider networks, access to and availability of services.
Supports quality improvement activities. Reports potential quality issues and concerns to the Medical Director and the Quality Management department.
Assists with claim appeal authorization reviews as needed.
What you will bring:

Education: Bachelor's degree in nursing or a behavioral health related field required, or an equivalent combination of education and experience; Master's degree preferred.

Experience: Three years of clinical case management and healthcare experience in the physical or behavioral setting required. Experience working with Managed Care, Medicaid and Medicare populations is preferred. Experience with concurrent review, quality improvement processes, ICD9, CPT4 and DRG coding preferred.

Knowledge, Skills, and Abilities: Knowledge of managed care and utilization management required. Demonstrates support for the company's mission, vision and values. Position requires excellent written and verbal and written communication skills, strong organizational and time management skills, strong interpersonal skills and the ability to handle multiple priorities. Ability to work independently with minimal supervision. Ability to work effectively with Colorado Access staff, members, physician office staff and other providers. Requires basic computer knowledge with experience in Microsoft Word and Excel preferred. May be required to manage multiple priorities and projects with tight deadlines.

Licenses/Certifications: Active Colorado Nursing (i.e. RN, LPN) or Mental Health licensure (i.e. LCSW, LPC) required or a combination of experience and education can substitute for a period of one year while the license is being obtained. A valid driver's license and proof of current auto insurance will be required for any position requiring driving.

Together we will be: an innovative and collaborative team who supports each other, the employees and vision of the company to reach our goals individually, together and as an organization.

Pay, Perks and Benefits at Colorado Access:

The compensation for this position is $35.00 per hour

and is a non-exempt (hourly) position. The pay rate/salary is commensurate with experience.

Pro Re Nada (PRN) employees are not eligible for benefits.

Where you will work:

This position will be an offsite model work environment. Approximately 80%-100% offsite, not at the office.

We are not able to support out of state employees at this time as we continue to serve our members and community in the metro Denver area and across the beautiful state of

Colorado Access is committed to providing equal opportunities to all people regardless of race, color, national origin, age, sex, genetic information, religion, pregnancy, disability, sexual orientation, veteran status or any other status protected by applicable law. We strive to maintain a work environment that is free from unlawful harassment and discrimination.

Other details

Job Function Staff
Pay Type Hourly
Min Hiring Rate $35.00
Max Hiring Rate $35.00

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