Remote Utilization Review RN – Admission & Denials

Mountain Region Out of State Staffing; Centennial (CO); Remote; USD 90,000 - 115,000; Full time

Job summary

CommonSpirit is seeking an Utilization Review RN to meticulously review medical records for admission status, continued hospitalization, and payer authorization, collaborating with Concurrent Denial RNs and Patient Access to protect financial integrity.

You will perform admission, concurrent and post-discharge reviews, ensuring compliance with UR principles, hospital policies, PRO, Joint Commission, and payer criteria, while communicating with providers and payers.

Qualifications

• Associate's Degree in Nursing is required.
• 2 years acute hospital clinical experience or Masters in lieu of 1 year.
• RN license with a participating state license per NLC.
• Ability to pass annual Interrater reliability test.
• Knowledge of CMS standards and requirements.

Responsibilities

• Review admission, concurrent and post-discharge records to verify appropriate status.
• Identify root causes of denials with Concurrent Denial RNs and implement prevention.
• Collaborate with Patient Access to verify payer sources and obtain inpatient authorization.
• Document interactions and maintain communications with physicians, payers, and Care Coordinators.
• Support second-level physician reviewer and coordinate peer-to-peer discussions.

Skills

Critical thinking

Problem solving

Communication

Collaboration

Education

Associate's Degree in Nursing

RN Licensure/Compact

Masters degree in Case Management or Nursing

BSN

Job description

CommonSpirit is seeking an Utilization Review RN to meticulously review medical records for admission status, continued hospitalization, and payer authorization, collaborating with Concurrent Denial RNs and Patient Access to protect financial integrity.

You will perform admission, concurrent and post-discharge reviews, ensuring compliance with UR principles, hospital policies, PRO, Joint Commission, and payer criteria, while communicating with providers and payers.