Utilization Review RN: Payer & Care Coordination

Longmont United Hospital; United States; On-site; USD 90,000 - 110,000; Full time

Job summary

Longmont United Hospital in Colorado seeks an experienced Utilization Review RN to review medical records, confirm admission status, and coordinate with payers and care teams to ensure appropriate utilization and financial integrity.

You will work with Concurrent Denial RNs, physicians, and Care Coordinators to ensure timely reviews, adherence to guidelines, and compliant documentation across admission, concurrent, and post-discharge stages.

Qualifications

• Associate's degree in nursing required; BSN preferred for advancement.
• Two years of acute hospital clinical experience or a master’s in case management in lieu of one year.
• RN license in good standing; ability to pass reliability tests for utilization reviews.
• Knowledge of CMS standards and utilization management concepts.

Responsibilities

• Review medical records to confirm admission status and ongoing hospitalization.
• Coordinate with Concurrent Denial RNs to identify root causes of denials and prevention.
• Verify payer sources with Patient Access and document interactions.
• Communicate with physicians, payers, and Care Coordinators about review outcomes.
• Support second-level physician reviewer and document DRG at initial review.

Skills

Critical thinking

Problem solving

Professional communication

Team collaboration

Time management

Education

Associate's Degree in Nursing

Bachelor's Degree in Nursing (BSN)

Job description

Longmont United Hospital in Colorado seeks an experienced Utilization Review RN to review medical records, confirm admission status, and coordinate with payers and care teams to ensure appropriate utilization and financial integrity.

You will work with Concurrent Denial RNs, physicians, and Care Coordinators to ensure timely reviews, adherence to guidelines, and compliant documentation across admission, concurrent, and post-discharge stages.