Utilization Review RN

Duties & Responsibilities

• Affirms all new inpatient admissions for identification of status and medical necessity for admission; communicates clinical review process with appropriate Payors.
• Affirms the continuity of care in conjunction with the Case Managers regarding the continued medical necessity of hospitalization and the status of the discharge plan; communicates this to the appropriate payors.
• Collaborates with other members of the healthcare team to help identify and control inappropriate resource utilization.
• Conducts concurrent admission and continued stay reviews based on appropriate utilization review criteria.
• Utilizes information provided by Patient Access regarding authorized length of stay and follows up with third-party payors on an ongoing basis, documenting communications regarding continued authorizations.
• Follows up on denials communicated to the department and works with the revenue cycle staff to assist with appeals.
• Maintains and demonstrates appropriate clinical knowledge to assist physicians in providing documentation of severity of illness and intensity of service to assure that criteria for acute hospitalization are met.

Requirements

• Education: Bachelor of Science in Nursing (BSN)
• Experience: Three years of recent clinical or case management experience that includes recent UR experience in a hospital or with a Third-Party Payor
• Certification(s): BLS/CPR from the American Heart Association with at least 6 months left before expiration is required upon hire.
• Licensure(s): Registered Nurse License

Qualifications

• Minimum qualifications for this position include a Bachelor of Science in Nursing (BSN).
• Recent clinical or case management experience with recent UR experience in a hospital or with a Third-Party Payor is required.
• BLS/CPR certification from the American Heart Association is required and must have at least 6 months left before expiration upon hire.
• A Registered Nurse license is required.

Skills

• Knowledge of utilization review processes and guidelines
• Ability to communicate effectively with healthcare providers and payors
• Strong analytical and problem-solving skills
• Attention to detail and ability to manage multiple tasks simultaneously

Benefits

Here, you matter. As a Children’s Hospital Colorado team member, you will receive a competitive pay and benefits package designed to take care of your needs that includes base pay, incentives, paid time off, medical/dental/vision insurance, company provided life and disability insurance, paid parental leave, 403b employer match (retirement savings), a robust wellness program, and access to professional development tools, including an education benefit to help you advance your career. As part of our Total Rewards package, Children's Colorado offers an annual employee bonus program that rewards eligible team members based on organizational performance. If organizational goals are met for the year, the bonus is paid out the following April. Children’s Colorado delivers annual base pay increases to eligible team members based on their performance over the previous year.

Pay

Pay is dependent on applicant's relevant experience. Annual Salary Range (Based on 40 hours worked per week): $84,558.69 to $126,838.03

Schedule

The position is expected to stay open until the posted close date. Please submit your application as soon as possible as the posting is subject to close at any time once a sufficient pool of qualified applicants is obtained.