Utilization Review Nurse

11 hours ago


Grand Junction, Colorado, United States HexaQuEST Health, Inc. Full time
Job Description:

Utilization Review Experience Required

Work Schedule:

  • Full Time

Location:

  • Community Hospital

Responsibilities:

Maintain and improve the case management system by interacting with patients, physicians, and other healthcare providers to achieve clinical, operational, and financial outcomes for patient populations.

Collaborate with physicians, patients, families, staff, and payers to provide effective and cost-efficient care for patient populations.

Coordinate clinical review requests from payer sources to ensure timely reviews and payments to the hospital.

Participate in departmental and interdepartmental meetings related to Case Management/Social Services/Discharge Planning functions.

Education and/or Experience:

Bachelor's Degree in Nursing with at least three years of clinical experience in a hospital setting, at least three years of case management experience in a hospital setting, and at least two years of Utilization Review experience with knowledge of evidence-based criteria guidelines or equivalent combination of education and experience.

Certificates/Licenses:

  • Current unrestricted Registered Nurse license in the State of Colorado (required)
  • Case management certification (preferred) or will obtain within 1 year of employment

Position Urgency:

  • Quick Start

Shifts:

  • Full-Time

State License Details:

  • Must Be Currently Active

Minimum Years of Experience:

  • 2

Minimum Guaranteed Hours:

  • 40

Specialty Type:

  • Nursing

Sub Specialty:

  • Utilization Review RN

Bilingual:

  • No

EMR Used:

  • No Listing

Holiday Coverage Required:

  • No


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