Utilization Review RN: Optimize Care & Compliance

CommonSpirit Health; Centennial (CO); Hybrid; USD 55,000 - 80,000; Full time

Job summary

CommonSpirit Health in Centennial, Colorado seeks an Utilization Review RN to review medical records for admission status and ongoing hospitalization, ensuring quality care and fiscal integrity. You will collaborate with Concurrent Denial RNs and Patient Access to verify payer sources and obtain inpatient authorizations.

You will perform admission, concurrent, and post-discharge reviews, ensuring compliance with UR principles, hospital policies, and external regulators.

Qualifications

• Associate’s Degree in Nursing is required.
• RN license in good standing in participating state.
• Master’s in Case Management or related field preferred in lieu of one year experience.
• Knowledge of CMS standards and utilization management.

Responsibilities

• Conduct admission, concurrent, and post-discharge reviews per UR guidelines.
• Identify denials and implement preventive strategies with Concurrent Denial RNs.
• Coordinate with Patient Access and payers for inpatient authorizations.
• Communicate outcomes to physicians, payers, and Care Coordinators.
• Support peer-to-peer discussions and document DRGs for assigned patients.

Skills

Critical thinking

Professional communication

Collaborative team player

Time management

Education

Associate’s Degree in Nursing

Master's degree in Case Management

Bachelor’s Degree in Nursing (BSN)

Job description

CommonSpirit Health in Centennial, Colorado seeks an Utilization Review RN to review medical records for admission status and ongoing hospitalization, ensuring quality care and fiscal integrity. You will collaborate with Concurrent Denial RNs and Patient Access to verify payer sources and obtain inpatient authorizations.

You will perform admission, concurrent, and post-discharge reviews, ensuring compliance with UR principles, hospital policies, and external regulators.