Utilization Review RN at CommonSpirit Health Mountain Region

Centennial, Colorado, United States -

Full Time

Start Date

Immediate

Expiry Date

25 Jan, 26

Salary

54.46

Posted On

27 Oct, 25

Experience

5 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Utilization Review, Critical Thinking, Collaboration, Clinical Guidance, Evidence-Based Guidelines, Patient Access, Authorization, Denial Prevention

Industry

Hospitals and Health Care

Description

Welcome to CommonSpirit Health Mountain Region CommonSpirit Health Mountain Region is committed to building healthier communities, advocating for those who are poor and vulnerable, and innovating how and where healing can happen—both inside our hospitals and out in the community. With locations throughout Colorado, Utah, and Kansas, we deliver the same high standard of care to our employees as we do to our patients. Our 20 hospitals, emergency and urgent care centers, home care and hospice, Flight for Life ColoradoTM , telehealth and over 240 physician practices and clinics offer endless opportunities! Here, you can grow your career and impact the people in the communities you serve. CommonSpirit Health is one of the nation’s largest nonprofit, faith-based health systems, with a team of over 150,000 employees and 25,000 physicians and advanced practice clinicians. CommonSpirit operates more than 2,200 care sites and 140 hospitals, serving some of the most diverse communities across the nation, letting humankindness lead the way. Overview You have a purpose, unique talents and now is the time to embrace it, live it and put it to work. We value incredible people with incredible skills – but your commitment to a greater cause is something we value even more. This is the heartbeat of our organization and your time will be spent in a supportive, team environment with resources to help you flourish and leaders who care about your success. The Utilization Review RN is responsible for the review of medical records for appropriate admission status and continued hospitalization. Works in collaboration with the attending physician, consultants, second level physician reviewer and the Care Coordination staff utilizing evidence-based guidelines and critical thinking. Additionally, as a Utilization Review RN, you will collaborate with the Concurrent Denial RNs to determine the root cause of denials and implement denial prevention strategies. Collaborates with Patient Access to establish and verify the correct payer source for patient stays and documents the interactions. Obtains inpatient authorization or provides clinical guidance to Payer Communications staff to support communication with the insurance providers to obtain admission and continued stay authorizations as required within the market. Schedule: Days (8:00am - 4:30pm) 7-days/week, Remote. Qualifications In addition to bringing humankindness to the workplace each day, qualified candidates will need the following: Minimum two (2) years of acute hospital clinical experience or a Masters degree in Case Management or Nursing field in lieu of 1 year experience. Utilization Review experience strongly preferred. Preferred graduate of an accredited school of nursing (Bachelor's Degree in Nursing (BSN)) or related healthcare field. At least five (5) years of nursing experience RN license in the state(s) covered is required. Physical Requirements - Medium Work - (Exert up to 50lbs force occasionally, and/or up to 20lbs frequently, and/or up to 10lbs constantly) Your Connected Community We believe in the healing power of humanity and serving the common good through our dedicated work and shared mission to celebrate humankindness. Our Total Reward Offerings We believe investing in our employees lets them know they truly matter. Your Total Rewards package includes compensation, benefits, retirement, wellness, leave, and other programs. Designed with your well-being in mind, we offer: Several Medical, Dental, & Vision options. Spending Accounts including a Dependent Care FSA that can include an employer contribution Retirement account options with a generous employer match Tuition Reimbursement Student Loan Forgiveness, and so much more! View more on our benefits HERE. Pay Range $34.14 - $54.46 / hour

Responsibilities

The Utilization Review RN is responsible for reviewing medical records for appropriate admission status and continued hospitalization. This role involves collaboration with various healthcare professionals to ensure proper patient care and authorization processes.