Utilization Review RN: Optimize Patient Care & Approvals

CommonSpirit Health; Centennial (CO); On-site; USD 47,000 - 84,000; Full time

Job summary

CommonSpirit Health is seeking a Utilization Review RN to review medical records for admission status and Continued hospitalization, working with physicians, reviewers, and care coordination staff to apply evidence-based guidelines. The role includes collaboration with payer communications staff to obtain authorizations and ensure proper payer sources.

The position requires RN licensure in the applicable states and typically calls for 2+ years in acute hospital settings; a BSN is preferred and a

Qualifications

• Minimum two years of acute hospital clinical experience (or a Master's in Case Management in lieu of 1 year).
• Utilization Review experience.
• RN license in the state(s) covered is required; BSN preferred.

Responsibilities

• Review medical records for admission status and continued hospitalization using evidence-based guidelines and clinical judgement.
• Collaborate with the attending physician, consultants, and care coordination staff to determine denial root causes and prevention strategies.
• Collaborates with Patient Access to establish and verify payer sources and to obtain authorizations for admission and continued stay as required.

Skills

Utilization Review experience

RN license

Acute hospital nursing

Education

Bachelor's Degree in Nursing (BSN)

Master's degree in Case Management or Nursing (preferred)

Job description

CommonSpirit Health is seeking a Utilization Review RN to review medical records for admission status and Continued hospitalization, working with physicians, reviewers, and care coordination staff to apply evidence-based guidelines. The role includes collaboration with payer communications staff to obtain authorizations and ensure proper payer sources.

The position requires RN licensure in the applicable states and typically calls for 2+ years in acute hospital settings; a BSN is preferred and a