Utilization Management RN

Company: UCHealth
Location: Arvada
Posted on: February 19, 2021

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: Part Time (20 hours a week, 40 hours per pay period), Day Shift

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:

• 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.
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Keywords: UCHealth, Arvada , Utilization Management RN, Healthcare , Arvada, Colorado