RN-Utilization Review, University Hospital

UofL Health • Louisville, KY

351d

About The Position

UofL Health is a fully integrated regional academic health system with nine hospitals, four medical centers, Brown Cancer Center, Eye Institute, nearly 200 physician practice locations, and more than 1,000 providers in Louisville and the surrounding counties, including southern Indiana. Additional access to UofL Health is provided through a partnership with Carroll County Memorial Hospital. Affiliated with the University of Louisville School of Medicine, UofL Health is committed to providing patients with access to the most advanced care available. This includes clinical trials, collaboration on research and the development of new technologies to both save and improve lives. With more than 14,000 team members - physicians, surgeons, nurses, pharmacists and other highly-skilled health care professionals, UofL Health is focused on one mission: to transform the health of communities we serve through compassionate, innovative, patient-centered care.

Requirements

• Licensed or eligible for license in Kentucky.
• Basic Life Support (BLS) accredited by the American Heart Association (AHA).
• BSN or RN with a Bachelor's Degree in Business or Health Care Administration preferred. Will consider RN with ASN if actively pursuing BSN, with BSN completion required within 2 years of hire.
• Minimum three years' experience as an RN plus minimum two years' experience performing utilization review and/or quality assurance activities in an acute care facility or HMO/PPO/PRO preferred.
• Ability to adjust priorities quickly, organize multiple tasks simultaneously, and work interdependently with many levels of staff.
• Attention to detail; strong organizational, interpersonal and communication skills; and innovative problem-solving skills required.
• Ability to adjust work hours depending upon departmental needs as determined by the director or manager.

Nice To Haves

• ANCC Certification in Nursing Case Management, ACM or CCM.

Responsibilities

• Perform activities which support the Utilization Management functions.
• Make clinical recommendations regarding medical necessity for admission and continued stay.
• Screen patients for client specific guidelines regarding insurance, Medicare and/or Medicaid guidelines.
• Send payor specific Notice of Admission and continued stay reviews.
• Communicate with physician and case managers regarding payor approval/denial of admission and continued stay review.
• Process payor denials and retro reviews.
• Promote optimal health care outcomes in accordance with the policies, procedures, applicable laws and contracts.
• Assume responsibility and accountability for the appropriate utilization of facilities and services.
• Serve as a resource to physicians.
• Conduct admission and concurrent reviews including observation and inpatients.
• Identify patients who do not meet criteria and take action to ensure patients are cared for in the most appropriate level of care.
• Coordinate care in conjunction with other members of the interdisciplinary healthcare team.
• Utilize the nursing process (assess, plan, implement and evaluate) and management process (plan, organize, direct and control) to provide a framework for decision-making.
• Maintain confidentiality of information.
• Actively support organizational goals and objectives by providing needed information to divisions and departments.

Benefits

• Competitive Pay & Benefits Options
• Paid Vacation, Sick days, and Holidays
• Free tuition to UofL for Part- and Full-time employees for Child/Spouse/Domestic Partner
• 401K with Employer Match

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Industry: Hospitals
• Education Level: Bachelor's degree