1+ months

Per- Diem RN Utilization Review - Boulder, CO

Boulder, CO 80302
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Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that's improving the lives of millions. Here, innovation isn't about another gadget, it's about making health care data available wherever and whenever people need it, safely and reliably. There's no room for error. Join us and start doing your life's best work.(sm)

The candidate will provide utilization management services, in coordination with other Case Management staff, using pre established guidelines and criteria to perform review activities in order to assure the proper utilization of hospital services and payment of those services by Medicare, Medicaid, and other third-party payors. In a pro active manner, the UR RN will provide the necessary medical information to justify the medical necessity of the hospital stay and will take necessary follow up action to assist in the appeal processes of denials.

Primary Responsibilities:

  • Professional Accountabilities:
    • Adheres to name badge/dress code compliance
    • Effectively problem-solves and actively pursues resolution
    • Directly communicates with staff, physicians, patients and families
    • Role models leadership behavior through courtesy, respect and efficiency
  • Utilization Management:
    • Assesses all new inpatient admissions for identification of status and admission necessity and makes initial proactive UR contact with appropriate Payor
    • Daily assess the continuity of care in conjunction with the Case Managers and Social Workers with regards to the continued medical necessity of hospitalization and the status of the discharge plan and communicates this to the Third-Party Payor
    • Coordinates with other Case Management staff to help identify and control inappropriate resource utilization
    • Conducts concurrent admission and continued stay reviews based on appropriate utilization review criteria. Review calls are returned on the same day when possible, and no later than the next business day
    • Without direct supervision, utilizing time constructively and organizing assignments for maximum productivity
    • Utilizes information provided by the Financial Counselors/Admissions regarding authorized length of stay and follows up with third-party payors on an ongoing basis, and documents in Bar the communications regarding continued authorizations
    • Follows up on denials communicated to the department and works with the Patient Accounting staff to assist with appeals
    • Administers denial of stay letters to patients as indicated
    • Maintains and demonstrates appropriate clinical knowledge in order to assist physicians in providing documentation of severity of illness and intensity of service in order to assure that criteria for acute hospitalization are met
    • Is familiar with Employees are expected to comply with all regulatory requirements, including Joint Commission Standards
    • Is familiar with organization, department and job specific Environment of Care areas, including Life Safety, Utilities Management, Hazardous Materials Communications, Emergency Preparedness, Infection Control and Medical Equipment Failure
    • Adheres to Standard Precautions as appropriate, which may include:
      • the use of protective barriers, as appropriate (e.g., gloves, masks, gowns, pocket masks, and/or safety glasses)
      • handling and disposing of infectious waste appropriately
      • hand washing as appropriate

When applicable, employees must be able to adjust the essential functions they perform appropriately to the age of their patient/customer. Employees must demonstrate knowledge of the principles of growth and development and the knowledge and skills necessary to provide for the primary population of patients served in the department. Employees demonstrate the ability to alter care and patient/family education based on the age or developmental level of the patient.

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.


Jobs Rated Reports for Registered Nurse

Posted: 2020-09-22 Expires: 2020-11-21

UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier lives and helping to make the health system work better for everyone.

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Per- Diem RN Utilization Review - Boulder, CO

UnitedHealth Group
Boulder, CO 80302

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Registered Nurse
118th2018 - Registered Nurse
Overall Rating: 118/220
Median Salary: $70,000

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