RN-Utilization Review, University Hospital, Remote Position

Santa Barbara Cottage Hospital; Louisville (KY); Remote; USD 60,000 - 90,000; Full time

Job summary

An established industry player in healthcare is seeking a Utilization Review RN to enhance patient care and optimize healthcare outcomes. This role involves making critical clinical recommendations, coordinating care with healthcare teams, and ensuring compliance with insurance guidelines. Join a dedicated team focused on compassionate, innovative care while enjoying competitive pay and comprehensive benefits. This position offers the opportunity to make a significant impact on patient lives and contribute to the mission of transforming community health through quality care.

Benefits

Competitive pay and benefits options

Paid vacation, sick days, and holidays

Free tuition for employees and dependents

401K with employer match

Qualifications

• Licensed or eligible for license in Kentucky.
• Minimum three years’ experience as an RN with two years in utilization review.

Responsibilities

• Make clinical recommendations regarding medical necessity for admissions.
• Screen patients based on insurance and communicate with physicians.

Skills

Utilization Review

Patient Care Coordination

Clinical Recommendations

Insurance Guidelines

Communication Skills

Education

Bachelor of Science in Nursing (BSN)

Associate Degree in Nursing (ASN)

Job description

Overview

We are Hiring at Jewish Hospital

Location: 530 S Jackson St, Louisville, KY 40202

Shift Options: Full Time, First

About Us

UofL Health is a fully integrated regional academic health system with nine hospitals, four medical centers, Brown Cancer Center, Eye Institute, nearly 200 physician practice locations, and more than 1,000 providers in Louisville and the surrounding counties, including southern Indiana. Additional access to UofL Health is provided through a partnership with Carroll County Memorial Hospital.

Affiliated with the University of Louisville School of Medicine, UofL Health is committed to providing patients with access to the most advanced care available. This includes clinical trials, collaboration on research, and the development of new technologies to both save and improve lives. With more than 14,000 team members – physicians, surgeons, nurses, pharmacists, and other highly-skilled healthcare professionals – UofL Health is focused on one mission: to transform the health of communities we serve through compassionate, innovative, patient-centered care. For more information, visit www.UofLHealth.org.

Our Mission

As an academic health care system, we will transform the health of the communities we serve through compassionate, innovative, patient-centered care.

Responsibilities

Under the direction of the Director, Care Coordination, the Utilization Review RN performs activities supporting the Utilization Management functions. Responsibilities include:

• Making clinical recommendations regarding medical necessity for admission and continued stay.
• Screening patients based on insurance, Medicare, and Medicaid guidelines.
• Sending payor-specific notices of admission and continued stay reviews.
• Communicating with physicians and case managers about payor approval or denial.
• Processing payor denials and retro reviews.
• Promoting optimal health care outcomes in accordance with policies, procedures, laws, contracts, and organizational values.
• Assuming responsibility for appropriate utilization of facilities and services.
• Serving as a resource to physicians.
• Conducting admission and concurrent reviews, including observation and inpatient care.
• Identifying patients not meeting criteria and taking appropriate actions.
• Coordinating care with the healthcare team to ensure optimal health and financial accountability.
• Utilizing nursing and management processes for decision-making.
• Maintaining confidentiality and supporting organizational goals.

Qualifications

Required Qualifications

• Licensed or eligible for license in Kentucky.
• Basic Life Support (BLS) certification by the American Heart Association.
• BSN or RN with a Bachelor's Degree in Business or Health Care Administration preferred. Will consider RN with ASN if actively pursuing BSN, with completion required within 2 years of hire.
• Minimum three years’ experience as an RN plus at least two years’ experience in utilization review or quality assurance in an acute care or managed care setting.

Preferred Qualifications

• ANCC Certification in Nursing Case Management, ACM, or CCM.

Benefits & Perks

• Competitive pay and benefits options.
• Paid vacation, sick days, and holidays.
• Free tuition at UofL for part- and full-time employees for themselves, children, spouse, or domestic partner.
• 401K with employer match.