Rn Utilization Review Prn

:

Proactively manage inpatient and outpatient utilization to assure that medical care is appropriate, efficient, and medically necessary. Support facility discharge planning efforts, coordination of transition of care and manage utilization through appropriate review of authorization requests.

Posting Specifics

Hours: PRN

Shift: Days

Scope

As a Utilization Review RN, you need to know how to:

• Work with multidisciplinary team to assess and improve denial management, documentation, and appeals process.
• Collaborate with case managers, physicians, and payers related to status, coverage, benefits, and discharge planning as needed.
• Use nationally recognized review criteria to ensure that patient status is at the appropriate level of care. Collaborate with physicians and care managers to support an appropriate and timely patient discharge.
• Review medical records and prepare for appropriate clinical appeals.
• Perform initial review and authorizations for admission. Perform concurrent reviews to ensure that extended stays are medically necessary and justification is documented in the medical record. Perform ongoing review of precertification and retrospective review for medical necessity. Participate in continued stay reviews. Communicate with attending physician regarding questions about continued length of stay, plan of care/discharge, and physician orders.
• Document all UR interventions in appropriate electronic record.
• Identify opportunities for physician education regarding length of stay, resource utilization and clinical documentation related to justification for hospital services.
• Refer appropriate cases to the designated Physician Advisor in accordance with established guidelines for admission status or continued stay.
• Understand CMS medical necessity requirements and the coordination of care required under Federal and State regulations.

Minimum Qualifications Required

• Minimum of three (3) years of case management experience
• Current Colorado RN license or compact license with the ability to obtain Colorado RN license
• Bachelor’s Degree in Nursing (BSN)

Preferred Qualification

• At least five (5) years of nursing experience

Physical Requirements:

Ongoing need for employee to see and assess various nonverbal cues used in patient diagnosis/assessment in order to understand and develop treatment options.- and -Frequent interactions with patient care providers, patients, and visitors that require employee to verbally communicate as well as hear and understand spoken information, as well as hear and respond quickly to emergent needs or issues that may arise with patients.

Location:

St Joseph Hospital

Work City:

Denver

Work State:

Colorado

Scheduled Weekly Hours:

0

The hourly range for this position is listed below. Actual hourly rate dependent upon experience.

$34.14 - $60.66

We care about your well-being – mind, body, and spirit – which is why we provide our caregivers a generous benefits package that covers a wide range of programs to foster a sustainable culture of wellness that encompasses living healthy, happy, secure, connected, and engaged.

Learn more about our comprehensive benefits packages for our Idaho, Nevada, and Utah based caregivers , and for our Colorado, Montana, and Kansas based caregivers our commitment to diversity, equity, and inclusion .