Utilization Review RN

CommonSpirit Health • Centennial, CO

19d • Remote

About The Position

We believe in the healing power of humanity and serving the common good through our dedicated work and shared mission to celebrate humankindness. Job Summary and Responsibilities You have a purpose, unique talents and now is the time to embrace it, live it and put it to work. We value incredible people with incredible skills – but your commitment to a greater cause is something we value even more. This is the heartbeat of our organization and your time will be spent in a supportive, team environment with resources to help you flourish and leaders who care about your success. The Utilization Review RN is responsible for the review of medical records for appropriate admission status and continued hospitalization. Works in collaboration with the attending physician, consultants, second level physician reviewer and the Care Coordination staff utilizing evidence-based guidelines and critical thinking. Additionally, as a Utilization Review RN, you will collaborate with the Concurrent Denial RNs to determine the root cause of denials and implement denial prevention strategies. Collaborates with Patient Access to establish and verify the correct payer source for patient stays and documents the interactions. Obtains inpatient authorization or provides clinical guidance to Payer Communications staff to support communication with the insurance providers to obtain admission and continued stay authorizations as required within the market. Schedule: Days (8:00am - 4:30pm) 7-days/week, Remote.

Requirements

• Minimum two (2) years of acute hospital clinical experience or a Masters degree in Case Management or Nursing field in lieu of 1 year experience.
• RN license in the state(s) covered is required.
• Physical Requirements - Medium Work - (Exert up to 50lbs force occasionally, and/or up to 20lbs frequently, and/or up to 10lbs constantly)

Nice To Haves

• Utilization Review experience strongly preferred.
• Preferred graduate of an accredited school of nursing (Bachelor's Degree in Nursing (BSN)) or related healthcare field.
• At least five (5) years of nursing experience

Responsibilities

• Responsible for the review of medical records for appropriate admission status and continued hospitalization.
• Works in collaboration with the attending physician, consultants, second level physician reviewer and the Care Coordination staff utilizing evidence-based guidelines and critical thinking.
• Collaborate with the Concurrent Denial RNs to determine the root cause of denials and implement denial prevention strategies.
• Collaborates with Patient Access to establish and verify the correct payer source for patient stays and documents the interactions.
• Obtains inpatient authorization or provides clinical guidance to Payer Communications staff to support communication with the insurance providers to obtain admission and continued stay authorizations as required within the market.

What This Job Offers

• Job Type: Full-time
• Number of Employees: 5,001-10,000 employees