Referral Clinical Review RN

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

Job Description:

Job DescriptionSummary: Establishes medical necessity for advanced services and procedures. Liaisons with providers, payers, and others to facilitate navigation of complex authorization and reimbursement processes. Work Schedule: Full Time Days Responsibilities: Reviews clinical documentation and guidelines for pending referrals, calling when necessary in an attempt to obtain authorization, mitigating the need for physician calls. Facilitates peer-to-peer reviews as needed. Identifies documentation requiring clarification, communicating with providers or other healthcare professionals to ensure medical necessity is supported. Serves as a resource to providers and other healthcare professionals regarding appropriateness of clinical documentation. Determines that medical necessity documentation and intent is established to meet Medicare compliance for diagnosis codes entered by providers. Changes diagnosis codes and documents details in EMR as needed. Initiates complex referrals on authorization portals, and trouble-shoots how best to navigate portals to obtain authorizations upon submission. Withinscope of job, requires critical thinking skills, decisive judgement and theability to work with minimal supervision. Must be able to work in afast-paced environment and take appropriate action. Requirements: * Minimum Required Education: Bachelor's degree in Nursing from an accredited Registered/Professional Nursing program. * Required Licensure/Certification: State licensure as a Registered Nurse (RN). Minimum Experience: 3 years of experience as an RN. * BLSthrough the American Heart Association or the American Red Cross CPR for theProfessional Rescuer with card in-hand before start date. BLS or CPRcard must be good through sixty days of hire. All life supportcertification cards must be issued by either the American Heart Association orthe American Red Cross CPR for the Professional Rescuer. (American Red Crossfor the Professional Rescuer is only good upon hire and all renewals will needto be through an American Heart Association sanctioned course.) IFAPPLICABLE: Are you a RN NewGrad? Visit tofind out about our exciting New Grad opportunities! At UCHealth, we do things differently Webelieve 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 thosewe serve. As Colorado's largest and most innovative healthcare system, we as a team deliver on the commitment to provide the bestpossible experience 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. Goingbeyond quality requires the perfect balance of talent, integrity, drive andintellectual curiosity. We are looking for individuals who recognize, like us,that the world of medicine is ever-changing and are motivated to do what isright, not what is easy. We support creativity and curiosity so thateach 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 meaningfulcareer. There's no limits to your potential here. Be Extraordinary. Join Us Today! UCHealthrecognizes and appreciates the rich array of talents and perspectives thatequal employment 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 , Referral Clinical Review RN, Other , Littleton, Colorado