Referral Clinical Review RN - Clinic
Company: UC Health
Location: Aurora
Posted on: May 22, 2023
|
|
Job Description:
Referral Clinical Review RN Apply now Save job Saved Description
Summary: Establishes medical necessity for advanced services and
procedures. Liaisons with providers, payers, and others to
facilitate navigation of complex authorization and reimbursement
processes. Work Schedule: Full Time Days Responsibilities: Reviews
clinical documentation and guidelines for pending referrals,
calling when necessary in an attempt to obtain authorization,
mitigating the need for physician calls. Facilitates peer-to-peer
reviews as needed. Identifies documentation requiring
clarification, communicating with providers or other healthcare
professionals to ensure medical necessity is supported. Serves as a
resource to providers and other healthcare professionals regarding
appropriateness of clinical documentation. Determines that medical
necessity documentation and intent is established to meet Medicare
compliance for diagnosis codes entered by providers. Changes
diagnosis codes and documents details in EMR as needed. Initiates
complex referrals on authorization portals, and trouble-shoots how
best to navigate portals to obtain authorizations upon submission.
Within scope of job, requires critical thinking skills, decisive
judgement and the ability to work with minimal supervision. Must be
able to work in a fast-paced environment and take appropriate
action. Requirements: Credentials: Essential: Registered Nurse
Other information: Minimum Required Education: Bachelor's degree in
Nursing from an accredited or state board of nursing approved
Registered/Professional Nursing program. Required
Licensure/Certification: State licensure as a Registered Nurse
(RN). Minimum Experience: 3 years of experience as an RN. 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.) Are you a
RN New Grad? Visit to find out about our exciting New Grad
opportunities! The pay range for this position is: $33.08 - $51.27
/ hour. Pay is dependent on applicant's relevant experience.
UCHealth offers a Five Year Incentive Bonus to recognize employee's
contributions to our success in quality, patient experience,
organizational growth, financial goals, and tenure with UCHealth.
The bonus accumulates annually each October and is paid out in
October following completion of five years' employment. UCHealth
offers their employees a competitive and comprehensive total
rewards package: Full medical, dental and vision coverage
Retirement plans to include pension plan and 403(b) matching Paid
time off. Start your employment at UCHealth with PTO in your bank
Employer-paid life and disability insurance with additional buy-up
coverage options Tuition and continuing education reimbursement
Wellness benefits 5 year incentive bonus Full suite of voluntary
benefits such as identity theft protection and pet insurance
Education benefits for employees, including the opportunity to be
eligible for 100% of tuition, books and fees paid for by UCHealth
for specific educational degrees. Other programs may also qualify
for up to $5,250 pre-paid by UCHealth or in the form of tuition
reimbursement each calendar year Loan Repayment: UCHealth is a
qualifying employer for the federal Public Service Loan Forgiveness
(PSLF) program! UCHealth provides employees with free assistance
navigating the PSLF program to submit their federal student loans
for forgiveness through Savi. At UCHealth, we do things differently
We believe 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 those we serve. As Colorado's largest
and most innovative health care system, we as a team deliver on the
commitment to provide the best possible experience for our patients
and their families. We foster a true human connection and give
people the freedom to live extraordinary lives. A career at
UCHealth is more than a job, it's a passion. Going beyond quality
requires the perfect balance of talent, integrity, drive and
intellectual curiosity. We are looking for individuals who
recognize, like us, that the world of medicine is ever-changing and
are motivated to do what is right, not what is easy. We support
creativity and curiosity so that each 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 meaningful
career. There's no limits to your potential here. Be Extraordinary.
Join Us Today! UCHealth recognizes and appreciates the rich array
of talents and perspectives that equal employment and diversity can
offer our institution. As an affirmative action/equal opportunity
employer, UCHealth is committed to making all employment decisions
based on valid requirements. No applicant shall be discriminated
against in any terms, conditions or privileges of employment or
otherwise be discriminated against because of the individual's
race, creed, color, religion, gender, national origin or ancestry,
age, mental or physical disability, sexual orientation, gender
identity, transgender status, genetic information or veteran
status. UCHealth does not discriminate against any "qualified
applicant with a disability" as defined under the Americans with
Disabilities Act and will make reasonable accommodations, when they
do not impose an undue hardship on the organization. Share:
Keywords: UC Health, Aurora , Referral Clinical Review RN - Clinic, Healthcare , Aurora, Colorado
Click
here to apply!
|