Utilization Management RN
Posted on: October 15, 2020
Ensures that services are delivered and documented in a manner that
balances quality of care with efficiency, cost-containment and
Work Schedule: Full Time (40 hours a week, 80 hours per pay
Reviews admissions and service requests within assigned unit for
prospective, concurrent, and retrospective medical necessity and/or
compliance with reimbursement policy criteria.
Provides case management and/or consultation for complex cases.
Assists departmental staff with issues related to Milliman (or
similar) guidelines, status determination, medical
records/documentation, precertification, reimbursement and
concurrent denials appeals.
Collaborates closely with case managers to make sure status' and
level of care is accurate. Communicates with payers as needed to
ensure patient accounts are secured.
Assesses and coordinates patient's discharge planning needs with
members of the healthcare team.
Withinscope of job, requires critical thinking skills, decisive
judgement and theability to work with minimal supervision. Must be
able to work in afast-paced environment and take appropriate
- Minimum Required Education: Bachelor's degree in Nursing.
- Required Licensure/Certification:
- State licensure as a Registered Nurse (RN).
- Basic Life Support (BLS) Healthcare Provider. BLS through the
American Heart Association or the American Red Cross CPR for the
Professional Rescuer with card in-hand before start date. BLS or
CPR card must be good through sixty days of hire. All life support
certification cards must be issued by either the American Heart
Association or the American Red Cross CPR for the Professional
Rescuer. (American Red Cross for the Professional Rescuer is only
good upon hire and all renewals will need to be through an American
Heart Association sanctioned course.)
- Minimum Experience: Five years of experience as a utilization
manager and five years as an RN in the assigned clinical area, with
demonstrated clinical competence. This clinical experience must
have taken place within the last five years of the nurse's
Are you a RN NewGrad? Visit
https://www.uchealth.org/professionals/residencies/ tofind out
about our exciting New Grad opportunities!At UCHealth, we do things
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Keywords: UCHealth, Aurora , Utilization Management RN, Executive , Aurora, Colorado
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