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Utilization Management RN

Location: Aurora, CO, United States
Category: Nursing Professional
Job Type: PRN
Job ID: 88011
Date Posted: Nov 22, 2022

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Description

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

Work Schedule: PRN Days

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:

  • Minimum Required Education: Bachelor's degree in Nursing. 
  • Required Licensure/Certification: State licensure as a Registered Nurse (RN).
  • Minimum Experience: Five years of experience as a utilization manager and five years as an RN in the assigned clinical area, with demonstrated clinical competence. This clinical experience must have taken place within the last five years of the nurse’s career.
  • Are you a RN New Grad? Visit https://www.uchealth.org/professionals/residencies/ to find out about our exciting New Grad opportunities!

The pay range for this position is: $36.47 - $56.52 / hour. Pay is dependent on applicant's relevant experience.

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 pension plan and 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
  • 5 year incentive bonus
  • 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.


    At UCHealth, we do things differently

    We believe in something different: a focus on the individuality of every person. In big ways and small, we exist to improve the extraordinary lives of all those we serve. As Colorado’s largest and most innovative health care system, we as a team deliver on the commitment to provide the best possible experience for our patients and their families. We foster a true human connection and give people the freedom to live extraordinary lives. A career at UCHealth is more than a job, it’s a passion.

    Going beyond quality requires the perfect balance of talent, integrity, drive and intellectual curiosity. We are looking for individuals who recognize, like us, that the world of medicine is ever-changing and are motivated to do what is right, not what is easy. We support creativity and curiosity so that each of us can find the extraordinary qualities within ourselves. At UCHealth, we’ll do everything in our power to make sure you grow and have a meaningful career. There’s no limits to your potential here.

    Be Extraordinary. Join Us Today!

    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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