Referral Clinical Review RN
Company: UCHealth
Location: Arvada
Posted on: February 21, 2021
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Job 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:
Essential:
* Registered Nurse
Minimum Required Education: Bachelor's degree in Nursing from an
accredited Registered/Professional Nursing program.
Required Licensure/Certification: State licensure as a Registered
Nurse (RN).
Minimum Experience: 3 years of experience as an RN.
This position's pay range starts at: $31.230000/hour.
An annual bonus may be paid to eligible employees based upon
organizational and individual performance.
UCHealth offers their employees a competitive and comprehensive
total rewards package. Some of the many benefits included in this
package are full medical, dental and vision coverage; retirement
plans; paid time off; employer-paid life and disability insurance
with additional buy-up coverage options; tuition and continuing
education reimbursement; and a full suite of voluntary benefits
such as identity theft protection and pet insurance. Our employees
and their family members have full access to our Employee
Assistance Program, which includes up to 5 free counseling visits
and work/life solutions, such as one free legal consultation. In
addition, other emotional counseling support is available depending
upon their need.
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.
Keywords: UCHealth, Arvada , Referral Clinical Review RN, Healthcare , Arvada, Colorado
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