Utilization Management RN

Description

Location : UCHealth UCHlth Leprino Building AMC, US : CO : Aurora

Department : UCH Utilization Management

FTE : Full Time, 1.0, 80.00 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 :

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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) :

Loan Repayment :

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.

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