Utilization Management RN

UCHealth

  • Aurora, CO
  • $38.91-60.31 per hour
  • Permanent
  • Full-time
  • 2 days ago
DescriptionLocation: UCHealth UCHlth Admin 2450 Peoria, US:CO:AuroraDepartment: UCHlth Patient Line ReferralsFTE: Full Time, 1.0, 80.00 hours per pay period (2 weeks)Shift: DaysPay: $38.91 - $60.31 / hour. Pay is dependent on applicant's relevant experienceSummary:
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:
  • 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 Three 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 three years' employment.UCHealth offers their employees a competitive and comprehensive total rewards package (benefit eligibility is based off of FTE status):
  • Medical, dental and vision coverage including coverage for eligible dependents
  • 403(b) with employer matching contributions
  • Time away from work: paid time off (PTO), paid family and medical leave (inclusive of Colorado FAMLI), leaves of absence; start your employment at UCHealth with PTO in your bank
  • Employer-paid basic life and accidental death and dismemberment coverage with buy-up coverage options
  • Employer paid short term disability and long-term disability with buy-up coverage options
  • Wellness benefits
  • Full suite of voluntary benefits such as flexible spending accounts for health care and dependent care, health savings accounts (available with HD/HSA medical plan only), identity theft protection, pet insurance, and employee discount programs
  • 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 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 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, color, national origin, language, culture, ethnicity, age, religion, sex, disability, sexual orientation, gender, veteran status, socioeconomic status, or any other characteristic prohibited by federal, state, or local law. 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.Who We Are (uchealth.org)AF123

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