Utilization Management RN

UCHealth•Aurora, CO

2d•Remote

About The Position

UCHealth is hiring a Utilization Management RN for a fully remote position. Applicants must reside in Colorado. The role is in the Patient Line Referrals department and works a full-time day schedule of 80 hours per two-week pay period. The RN ensures services are delivered and documented in a way that balances quality of care with efficiency, cost containment, and compliance. The position requires critical thinking, decisive judgment, the ability to work with minimal supervision, and the ability to take appropriate action in a fast-paced environment.

Requirements

Bachelor’s degree in Nursing.
State licensure as a Registered Nurse (RN).
At least 3 years of relevant experience.
Applicants must reside in Colorado.
If applicable, BLS through the American Heart Association or American Red Cross, with card in hand before the start date; the card must remain valid through 60 days after hire. Renewals must be issued by the American Heart Association.

Nice To Haves

3 years of utilization or case management experience.

Responsibilities

Review admissions and service requests within the assigned unit for prospective, concurrent, and retrospective medical necessity and compliance with reimbursement policy criteria.
Provide case management and consultation for complex cases.
Assist departmental staff with issues related to Milliman or similar guidelines, status determination, medical records and documentation, precertification, reimbursement, and concurrent denial appeals.
Collaborate with case managers to ensure patient status and level of care are accurate.
Communicate with payers as needed to ensure patient accounts are secured.
Assess and coordinate patients’ discharge planning needs with members of the healthcare team.

Benefits

3-Year Incentive Bonus.
Annual merit pay increase and annual market reviews of positions and base pay.
Medical, dental, and vision coverage.
24/7 mental health and well-being support for employees and dependents.
Discounted gym memberships and fitness resources.
Free Care.com membership.
Voluntary benefits, including accident insurance, critical illness insurance, group legal plan, identity theft protection, pet insurance, auto and home insurance, and employee discount programs.
Paid time off and paid family and medical leave, including Colorado FAMLI, as well as leaves of absence.
Employer-provided basic life and accidental death and dismemberment coverage, with buy-up coverage options.
Employer-provided short-term and long-term disability coverage, with a buy-up coverage option.
403(b) retirement plan with employer matching contribution; an additional 457(b) plan may be available.
Flexible spending accounts for health care and dependent day care; a health savings account is available with enrollment in a high-deductible medical plan.
Education support, including up to 100% of tuition, books, and fees for specific educational degrees; other programs may qualify for up to $10,000 per year prepaid or up to $5,250 per year in tuition reimbursement.
Access to LinkedIn Learning, internal professional development opportunities, and assistance navigating the Public Service Loan Forgiveness program.