Utilization Management RN-Care Management

Company: UCHealth
Location: Littleton
Posted on: October 12, 2020

Job Description:

Summary:

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

Work Schedule: Full Time Days

Responsibilities:

Reviews admissions and service requests within assigned unit for prospective,concurrent, and retrospective medical necessity and/or compliance withreimbursement policy criteria.

Provides case management and/or consultation for complex cases. Assists departmentalstaff with issues related to Milliman (or similar) guidelines, statusdetermination, medical records/documentation, precertification, reimbursementand concurrent denials appeals.

Collaborates closely with case managers to make sure status' and level of careis accurate. Communicates with payers as needed to ensure patient accounts aresecured.

Assesses and coordinates patient's discharge planning needs with members of thehealthcare team.

Within scope of job,requires critical thinking skills, decisive judgement and the ability to workwith minimal supervision. Must be able to work in a fast-pacedenvironment and take appropriate action.

Requirements:

Bachelor's degree in Nursing.

State licensure as a Registered Nurse (RN).

Basic Life Support (BLS) Healthcare Provider.

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.

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. All life support certification cards must be issued by either the American Heart Association or the American Red Cross CPR for the Professional Rescuer. (American Red Cross for the Professional Rescuer is only good upon hire and all renewals will need to be through an American Heart Association sanctioned course.)

At UCHealth, we do things differently

We believe insomething different: a focus on the individuality of every person. In big waysand small, we exist to improve the extraordinary lives of all those weserve. As Colorado's largest and most innovative health caresystem, we as a team deliver on the commitment to provide the best possibleexperience for our patients and their families. We foster a true humanconnection and give people the freedom to live extraordinary lives. A career atUCHealth is more than a job, it's a passion.

Going beyond qualityrequires the perfect balance of talent, integrity, drive and intellectualcuriosity. We are looking for individuals who recognize, like us, that theworld of medicine is ever-changing and are motivated to do what is right, notwhat is easy. We support creativity and curiosity so that each of uscan find the extraordinary qualities within ourselves. At UCHealth, we'll doeverything in our power to make sure you grow and have a meaningful career.There's no limits to your potential here.

Be Extraordinary. JoinUs Today!

UCHealth recognizesand appreciates the rich array of talents and perspectives that equalemployment and diversity can offer our institution. As anaffirmative action/equal opportunity employer, UCHealth is committed to makingall employment decisions based on valid requirements. No applicantshall be discriminated against in any terms, conditions or privileges ofemployment or otherwise be discriminated against because of the individual'srace, creed, color, religion, gender, national origin or ancestry, age, mentalor physical disability, sexual orientation, gender identity, transgenderstatus, genetic information or veteran status. UCHealth does notdiscriminate against any "qualified applicant with a disability" as definedunder the Americans with Disabilities Act and will make reasonableaccommodations, when they do not impose an undue hardship on the organization.

Keywords: UCHealth, Littleton , Utilization Management RN-Care Management, Other , Littleton, Colorado