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Utilization Review Nurse, Denver Health Medical Plan
*Must be Colorado resident. Job Summary Under minimal supervision the Utilization Review Nurse uses critical clinical thinking skills to perform initial inpatient or outpatient utilization review activities to determine the efficiency, effectiveness and quality of medical and behavioral health services. The Clinical Reviewer II, in collaboration with the UM Supervisor, serves as liaison between ordering and service providers and the Health Plan. This position makes medical determination decisions within defined protocols based on review of the service requests, clinical and non-clinical data, Member eligibility, and benefit levels in accordance to contract and policy guidelines. Position prepares letters to providers and member
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