Remote Utilization Review RN – Flexible Hours

Children's Hospital Colorado; Aurora (CO); On-site; USD 59,000 - 80,000; Part time

Job summary

Children's Hospital Colorado is seeking a Utilization Review RN to support medical necessity reviews and denial mitigation within a multidisciplinary team. The role is primarily remote with occasional onsite requirements; shifts are variable and may include days/evenings/weekends depending on staffing needs.

Licensure as RN and BSN required, with UR experience and BLS/CPR certification. The position emphasizes collaboration with payors, adherence to regulatory standards, and participation in the

Qualifications

• BSN required.
• Three years of UR experience in a hospital or with a Third-Party Payor.
• BLS/CPR certification with at least 6 months left before expiration.
• Registered Nurse license (RN).

Responsibilities

• Assesses all new inpatient admissions for identification of status and medical necessity for admission and communicates with Payors.
• Assesses continuity of care with Case Managers regarding continued medical necessity and discharge plan.
• Coordinates with the healthcare team to identify and control inappropriate resource utilization.
• Conducts concurrent admission and continued stay reviews based on UR criteria.
• Utilizes Payor communications and documents ongoing authorizations and stays.
• Follows up on denials and assists with appeals with revenue cycle staff.
• Maintains clinical knowledge to document severity of illness and intensity of service for criteria met.
• Complies with CMS and Joint Commission standards.

Education

Bachelor of Science in Nursing (BSN)

Job description

Children's Hospital Colorado is seeking a Utilization Review RN to support medical necessity reviews and denial mitigation within a multidisciplinary team. The role is primarily remote with occasional onsite requirements; shifts are variable and may include days/evenings/weekends depending on staffing needs.

Licensure as RN and BSN required, with UR experience and BLS/CPR certification. The position emphasizes collaboration with payors, adherence to regulatory standards, and participation in the