Utilization Management RN

4 weeks ago

Peyton, United States UC Health Full time
Description

Location: UCHealth UCHlth 2450 Peoria Admin Services, US:CO:Aurora

Department: UCHlth Patient Line Referrals

FTE: Full Time, 0.8, 64.00 hours per pay period (2 weeks)

Shift: Days

Pay: $38.91 - $60.31 / hour. Pay is dependent on applicant's relevant experience

Summary:
Ensures that services are delivered and documented in a manner that balances quality of care with efficiency, cost-containment and compliance.

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:

  • Registered Nurse
  • Bachelor's degree in Nursing.
  • State licensure as a Registered Nurse (RN).
  • 3 years of relevant experience. Preferred: 3 years of utilization or case management experience.
  • 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
We improve lives. In big ways through learning, healing, and discovery. In small, personal ways through human connection. But in all ways, we improve lives.

UCHealth invests in its Workforce.

UCHealth offers a Five Year Incentive Bonus to recognize employee's contributions to our success in quality, patient experience, organizational growth, financial goals, and tenure with UCHealth. The bonus accumulates annually each October and is paid out in October following completion of five years' employment.

UCHealth offers their employees a competitive and comprehensive total rewards package:
  • Full medical, dental and vision coverage
  • Retirement plans to include 403(b) matching
  • Paid time off. Start your employment at UCHealth with PTO in your bank
  • Employer-paid life and disability insurance with additional buy-up coverage options
  • Tuition and continuing education reimbursement
  • Wellness benefits
  • Full suite of voluntary benefits such as identity theft protection and pet insurance
  • Education benefits for employees, including the opportunity to be eligible for 100% of tuition, books and fees paid for by UCHealth for specific educational degrees. Other programs may also qualify for up to $5,250 pre-paid by UCHealth or in the form of tuition reimbursement each calendar year
Loan Repayment:
  • UCHealth is a qualifying employer for the federal Public Service Loan Forgiveness (PSLF) program UCHealth provides employees with free assistance navigating the PSLF program to submit their federal student loans for forgiveness through Savi.

UCHealth always welcomes talent. This position will be open for a minimum of three days and until a top applicant is identified.

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.

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