Remote Utilization Review RN - Part-Time 24h

Children's Hospital Colorado; Aurora (CO); Hybrid; USD 84,558 - 126,838; Part time

Job summary

Children's Hospital Colorado in Aurora, CO, is seeking an Utilization Review RN to support medical necessity reviews and denial mitigation as part of a multidisciplinary team. The role is primarily remote with potential onsite shifts, and requires BSN, 3 years UR experience, and BLS/CPR certification.

The position is part time (24 hours/week) within Utilization Management, with weekend evenings and relocation assistance if needed.

Qualifications

• BSN degree required.
• Three years of recent UR experience in hospital or with a payor.
• BLS/CPR certification with at least 6 months before expiration.

Responsibilities

• Assesses all new inpatient admissions for status and medical necessity and communicates with payors.
• Assesses continuity of care with Case Managers regarding ongoing medical necessity and discharge plans.
• Coordinates with the healthcare team to identify and control inappropriate resource utilization.
• Conducts concurrent admission and continued stay reviews based on UR criteria.
• Uses information from Patient Access to follow up on authorizations with payors.
• Follows up on denials and assists with appeals with Revenue Cycle.
• Maintains clinical knowledge to help physicians document severity of illness and intensity of service for acute hospitalization criteria.
• Complies with CMS and Joint Commission Standards.

Skills

UR experience

Clinical nursing

Education

BSN

RN License

Job description

Children's Hospital Colorado in Aurora, CO, is seeking an Utilization Review RN to support medical necessity reviews and denial mitigation as part of a multidisciplinary team. The role is primarily remote with potential onsite shifts, and requires BSN, 3 years UR experience, and BLS/CPR certification.

The position is part time (24 hours/week) within Utilization Management, with weekend evenings and relocation assistance if needed.