Part-Time RN: Utilization Review & Discharge Coordinator

Pioneers Medical Center; Northern (KY); Hybrid; USD 45,000 - 73,000; Part time

Job summary

Pioneers Medical Center is seeking a Part-Time Utilization Review Nurse (RN) to assess medical necessity and appropriateness of admissions and care levels in a Colorado hospital setting. This role includes concurrent and retrospective reviews, collaboration with physicians and Case Management, and documentation in the EHR.

Strong knowledge of payer guidelines is essential. The position supports discharge planning and appeals processes, with an emphasis on reducing readmissions and denials, and

Qualifications

• Active, unencumbered RN license in Colorado or a Compact-state license that includes Colorado.
• Two to three years of recent clinical experience in an acute care setting.
• One year of experience in Utilization Review or Case Management preferred.
• Strong knowledge of Medicare, Medicaid, and commercial payer regulations.

Responsibilities

• Conduct utilization reviews to determine medical necessity and appropriate level of care.
• Perform concurrent and retrospective utilization reviews using InterQual /Milliman criteria.
• Communicate with physicians and staff regarding medical necessity and documentation requirements.
• Identify barriers to discharge and collaborate with Case Management for timely progression.
• Document all activities in the EHR and assist with appeals for denied services.
• Stay current with payer regulations and medical necessity criteria.
• Coordinate discharge planning with orthopedic patients and UR committee involvement.

Education

Registered Nurse license (Colorado or Compact-state)

Job description

Pioneers Medical Center is seeking a Part-Time Utilization Review Nurse (RN) to assess medical necessity and appropriateness of admissions and care levels in a Colorado hospital setting. This role includes concurrent and retrospective reviews, collaboration with physicians and Case Management, and documentation in the EHR.

Strong knowledge of payer guidelines is essential. The position supports discharge planning and appeals processes, with an emphasis on reducing readmissions and denials, and