Utilization Review Nurse - Part Time

Weld County Government Greeley , CO 80634

Posted 3 days ago


Determines eligibility for Medicaid long term home health clients and authorizes appropriate services. Provides support to the case management team around utilization of home health services.


Position is up to 10HRS a WEEK

Position is considered NON-BENEFITED


Essential Duties and Responsibilities

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Other duties may be assigned. (Any one position may not include all of the duties listed nor do the listed examples include all duties which may be found in positions of this class.)

Complete comprehensive face to face functional assessments with clients in their home as is mandated by need and regulations to determine eligibility for long term home health services.

Review prior authorization requests (PARS) and home health care plans submitted by home health agencies for appropriateness of skilled care to be provided to Medicaid clients. Consult with home health agency staff, physicians and other medical professionals, and/or clients and families to aid in determination of appropriateness of services and medical necessity.

Refer clients to appropriate community resources to assist in meeting client needs.

Make all home health service denials in cases where services do not meet the medical necessity and/or level of care criteria under program requirements and participate in appeal hearings.

Assist case management staff in the determination of appropriateness of long term care services and medical necessity as needed. Assist in covering case management tasks for new referrals from the Intake Unit as well as for ongoing cases as needed.

Accurately establish and maintain client physical and digital files in accordance to SEP contract and program regulations including maintaining all standards related to the Benefits Utilization System (BUS). Maintain all standards related to client confidentiality and HIPAA regulations.



Required Education:

  • Successful completion of a two-year RN or Bachelors Degree in nursing.

  • Must possess a current Colorado Nursing License.

Preferred Work Experience:

  • Experience as a nurse in a home health care or nursing home setting.

  • Experience working with a diverse population including disabled individuals of all ages, aging populations and individuals with behavioral mental health needs.

  • Experience working with or knowledge of community resources and other community based services for the aging or disabled population.

  • Experience performing needs assessments and/or care planning for individuals.

Required Skills, Knowledge and Abilities:

  • Must have a valid Colorado Driver's License and Liability Insurance. Must provide own transportation and be willing to travel throughout Weld County.

  • Must pass Human Services Background Checks.

Other Necessary Requirements


Ability to enter data into several different computer programs. Ability to learn and apply new computer skills on a regular basis. Knowledge of computer programs such as Microsoft Windows and Word, Excel, and Outlook.

Ability to read and comprehend instructions, correspondence and department policies and procedures. Ability to write correspondence.

Ability to effectively communicate in one-on-one and small group situations to customers, clients and other employees of the organization.

Ability to apply math concepts and calculations in the work environment.

Ability to apply common sense to problem solve in a work environment.

Ability to adapt to fast paced, high volume and ever-changing work environment and be able to handle high stress situations.

Attend meetings, trainings, and conferences related to SEP programs administered and clients served.

Ability to stay informed of and comply with latest rules, regulations, and legislative issues that may impact the Long-Term Care System and attend all appropriate local and state meeting, committees, workshop and conferences.

Follow Human Services policies and procedures, the Weld County Code of Conduct and adhere to strict confidentiality guidelines and appropriate release of information outlined in both. Adhere to strict confidentiality guidelines and appropriate release of information.

While performing the duties of this job, the employee is regularly required to talk or hear. The employee may be required to sit for extended periods of time and is occasionally required to stand and walk. Occasionally the employee may be required to lift and/or move heavy files or objects up to 25 pounds. The employee frequently is required to use their hands and reach with hands and arms. Specific vision abilities required for this job include close vision, distance vision, peripheral vision, and ability to adjust focus such as that used when using a computer or reading.

upload resume icon
See if you are a match!

See how well your resume matches up to this job - upload your resume now.

Find your dream job anywhere
with the LiveCareer app.
Mobile App Icon
Download the
LiveCareer app and find
your dream job anywhere
App Store Icon Google Play Icon

Boost your job search productivity with our
free Chrome Extension!

lc_apply_tool GET EXTENSION

Similar Jobs

Want to see jobs matched to your resume? Upload One Now! Remove
Part Time Nabisco Merchandiser Greeley/Loveland CO

Mondelez International, Inc.

Posted 2 days ago

VIEW JOBS 1/15/2019 12:00:00 AM 2019-04-15T00:00 With our portfolio of global Power Brands such as Oreo and belVita biscuits, Cadbury Dairy Milk and Milka chocolate and Trident gum, we're the world's #1 in biscuits and candy, and #2 in chocolate and gum. We're Mondelēz International, a snacking powerhouse with operations in more than 80 countries, with approximately 90,000 employees globally and our brands are marketed in around 165 countries. Our purpose and vision is to create more MOMENTS OF JOY by building the BEST SNACKING COMPANY IN THE WORLD. As a part of Sales, you'll put our customers at the heart of our business. By building strong relationships with every customer, big or small, you'll help Mondelēz International become the supplier of choice and ensure we deliver world-class execution of our business plans in every store. Primary Role: The role of the Mondelēz International Sales Service Representative (Merchandiser) is to build a world-class Direct Store Delivery (DSD) business at the retail level by fulfilling the merchandising needs of our grocery-related customers. As a Merchandiser for our company you are primarily, though not exclusively, merchandising Nabisco specific brands. Areas of focus will include full-shelf conditions, neatly-merchandised displays and shelves, building display point-of-sale in all areas of the store, properly-rotated product on the shelf, and accurate price tags / point-of-sale in all departments. A major objective of this role is to establish and maintain rapport with key store individuals, while providing outstanding customer service. This role will be responsible for maintaining a timely and accurate merchandising call schedule. This role will also be responsible for identifying and communicating individual store opportunities to the appropriate Mondelēz International personnel. Mondelēz International is an employer of inclusion who partners with diversity groups which cater to people of all ethnicities, genders, ages and sexual orientations. Mondelēz International also works with military veterans to help hire our heroes who have served our nation, as well as partner with disability networks to include people of all abilities to help the company succeed for years to come. Benefits and Compensation: The PART-TIME Sales Service Representative position offers a competitive hourly compensation rate, work related mileage reimbursement and an Employee Assistance Program. Key Competencies: * Ability to perform hard work in a fast-pace work environment and meet the defined physical activities (frequent lifting, bending, and carrying up to 25 lbs., occasionally over 50 lbs., pushing, pulling, etc.) while adhering to the safety expectations and processes * Planning and organizing skills * Effective communication skills * Creativity * Flexibility * Detail-oriented * Problem solving skills * Computer literate (Microsoft Office, Internet and Cellular/Wireless devices) Requirements: * You must be at least 18 years of age, have a valid driver's license, reliable transportation, proof of auto insurance and have access to the internet with a personal email account. * A flexible work schedule is required, including being available to work weekends and holidays. * Previous retail / grocery experience a plus. * Successful completion of drug test, MVR check, and general background check. Mondelēz Global LLC is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, creed, sex, gender, national origin, disability, protected Veteran status, uniform service, sexual orientation, gender identity, gender expression, genetic information, or any other characteristic protected by law. Applicants who require accommodation to participate in the job application process may contact 847-943-5460 for assistance. Applicants must complete all required steps in the application process, including providing education and work history, in order to be considered for this position. All applicants will receive an email after submitting the first stage of the application. This email will include a link to return to the second stage of the application process. If you had previously submitted a resume, you will need to confirm/verify education and work history. For those that did not submit a resume, you will need to manually enter education and work history. Mondelez International, Inc. Greeley CO

Utilization Review Nurse - Part Time

Weld County Government