Utilization Management RN

Company: UCHealth
Location: Aurora
Posted on: October 15, 2020

Job Description:

Summary:

Ensures that services are delivered and documented in a manner that balances quality of care with efficiency, cost-containment and compliance.

Work Schedule: Full Time (40 hours a week, 80 hours per pay period), Days

Responsibilities:

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 action.

Requirements:

• 
  
• 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 career.
      
      
      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 differently
      
      Webelieve in something different: a focus on the individuality of every person.In big ways and small, we exist to improve the extraordinary lives of all thosewe serve. As Colorado's largest and most innovative healthcare system, we as a team deliver on the commitment to provide the bestpossible experience for our patients and their families. We foster a true humanconnection and give people the freedom to live extraordinary lives. A career atUCHealth is more than a job, it's a passion.
      
      Goingbeyond quality requires the perfect balance of talent, integrity, drive andintellectual curiosity. We are looking for individuals who recognize, like us,that the world of medicine is ever-changing and are motivated to do what isright, not what is easy. We support creativity and curiosity so thateach of us can find the extraordinary qualities within ourselves. At UCHealth,we'll do everything in our power to make sure you grow and have a meaningfulcareer. There's no limits to your potential here.
      
      Be Extraordinary. Join Us Today!
      
      UCHealthrecognizes and appreciates the rich array of talents and perspectives thatequal employment and diversity can offer our institution. As anaffirmative action/equal opportunity employer, UCHealth is committed to makingall employment decisions based on valid requirements. No applicantshall be discriminated against in any terms, conditions or privileges ofemployment or otherwise be discriminated against because of the individual'srace, creed, color, religion, gender, national origin or ancestry, age, mentalor physical disability, sexual orientation, gender identity, transgenderstatus, genetic information or veteran status. UCHealth does notdiscriminate against any "qualified applicant with a disability" as definedunder the Americans with Disabilities Act and will make reasonableaccommodations, when they do not impose an undue hardship on the organization.

Keywords: UCHealth, Aurora , Utilization Management RN, Executive , Aurora, Colorado