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Utilization Review Registered Nurse

Company:
SCL Health
Location:
Denver, CO
Post Date:
July 12, 2021
Job Status:
Part-Time
Description:

You.

 

 You bring your body, mind, heart and spirit to your work as a Utilization Review Registered Nurse.

 

Your compassion is tangible: patients feel it in the hand they hold. Families feel it in your prayers. Colleagues feel it in your support.  

 

Youre equally comfortable with integrated case management, working independently, and working with an interdisciplinary team.

 

Youre great at what you do, but you want to be part of something even greater. Because you believe that while individuals can be strong, the right team is invincible.

 

 Us.

 

Saint Joseph Hospital is part of SCL Health, a faith-based, nonprofit healthcare organization that focuses on person-centered care. Our 365-bed facility is one of the top-ranked hospitals in Denver, and has been awarded the highest national recognition possible for nursing excellence  Magnet designation  by the ANCC. We are proud to extend the mission of SCL Health by providing care for the poor, the vulnerable, our communities and each other. Our deep community roots date back to 1873, making us one of the oldest hospitals in Colorado.

 

Benefits are one of the ways we encourage health for you and your family. Our generous package includes medical, dental and vision coverage. But health is more than a well-working body: it encompasses body, mind and social well-being. To that end, weve launched a Healthy Living program to address your holistic health. Healthy Living includes financial incentives, digital tools, tobacco cessation, classes, counseling and paid time off. We also offer financial wellness tools and retirement planning.

 

We.

 

Together well align mission and careers, values and workplace. Well encourage joy and take pride in our integrity.

 

Well laugh at each others jokes (even the bad ones). Well hello and high five. Well celebrate milestones and acknowledge the value of spirituality in healing.

 

Were proud of what we know, which includes how much there is to learn.

 

Your day.

 

As a Utilization Review RN you need to know how to:

 
     
  • Use nationally recognized review criteria to ensure that patient status is at the appropriate level of care. Collaborate with physicians and care managers to support an appropriate and timely patient discharge.
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  • Understand CMS medical necessity requirements and the coordination of care required under Federal and State regulations.
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  • Perform initial review and authorizations for admission. Perform concurrent reviews to ensure that extended stays are medically necessary and justification is documented in the medical record. Perform ongoing review of precertification and retrospective review for medical necessity. Participate in continued stay reviews. Communicate with attending physician regarding questions about continued length of stay, plan of care/discharge, and physician orders.
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  • Refer appropriate cases to the designated Physician Advisor in accordance with established guidelines for admission status or continued stay.
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  • Collaborate with case managers, physicians, and payers related to status, coverage, benefits, and discharge planning as needed.
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  • Review medical records and prepare for appropriate clinical appeals.
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  • Identify opportunities for physician education regarding length of stay, resource utilization and clinical documentation related to justification for hospital services.
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  • Work with multidisciplinary team to assess and improve denial management, documentation, and appeals process.
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  • Document all UR interventions in appropriate electronic record.
  •  
 

 

 

Your experience.

 

We hire people, not resumes. But we also expect excellence, which is why we require:

 
     
  • Graduate of an accredited school of nursing (Bachelors Degree in Nursing (BSN) may be required for some care sites)
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  • Current Colorado RN license or compact license with the ability to obtain Colorado RN license
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  • Minimum of three (3) years of case management experience
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  • Demonstrated knowledge of medical terminology and desktop software, including Microsoft Office
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Preferred:

 
     
  • Bachelors Degree in Nursing (BSN) (BSN may be the minimum requirement at some care sites)
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  • At least five (5) years of nursing experience
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Your next move.

 

Now that you know more about being a Utilization Review RN on our team we hope youll join us. At SCL Health youll reaffirm every day how much you love this work, and why you were called to it in the first place.

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