UCHealth: Utilization Management Rn-Utilization Management

Company: UCHealth
Location: Arvada
Posted on: November 21, 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 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. 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: * Bachelor's degree in Nursing. * State licensure as a Registered Nurse (RN). * Basic Life Support (BLS) Healthcare Provider. * 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. * 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.) 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 witha 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. IND123 #GD1

Keywords: UCHealth, Arvada , UCHealth: Utilization Management Rn-Utilization Management, Executive , Arvada, Colorado