Utilization Management RN

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: $ $60.31 / hour. Pay is dependent on applicant's relevant experience

This position is an onsite role and does not offer a hybrid or remote option

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:

• 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.

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