RN Utilization Review Full Time Days

Location
Littleton, CO
Salary
Competitive
Posted
Feb 15, 2018
Closes
Mar 02, 2018
Specialty
Managed Care, Other
Contract Type
Permanent
Hours
Full Time
Littleton Adventist Hospital is a 231-bed, full-service medical center delivering quality care and Level II emergency care for more than 25 years. Located in the Denver suburb of Littleton, CO, the hospital is surrounded by residential neighborhoods, retail, dining, Littleton’s charming “old town” area, and abundant outdoor space with trails, nature centers and golf courses. In addition to numerous awards for care excellence, we are also leading the way in health care environmental sustainability. Our associates are actively engaged in protecting the health of our environment, working tirelessly to minimize the negative environmental impacts from our operations. Our sustainable achievements have been recognized with several local and national awards, including the Top 25 Environmental Excellence Award from Practice Greenhealth for three consecutive years (2014- 2016). View this shor video to learn why our associates love working here and how our mission and culture help to create fulfilling careers: https://centura-21.wistia.com/medias/e0qve9d10v

Job Description/Job Posting ID: 123830

Recruiter Contact: MandyGray@Centura.org

Clinic/Department: 8679 LAH UTILIZATION MANAGEMENT

Hospital: LITTLETON ADVENTIST HOSPITAL

Schedule: Full Time Days

Shift: .90 FTE- Most shifts start at 7-7:30am

Position Summary

Utilizes clinical expertise, discretion, and independent judgment in assessing/reassessing, facilitating care coordination, and patient advocacy. Responsible for assuring medical appropriateness criteria are met for status and level of care.

Minimum Education Requirements

BSN Required

Minimum Experience Requirements

1 year of nursing or case management experience.

Three years of recent acute care experience or case management experience, strongly preferred.

Experience in working with EMR. Working knowledge of regulatory requirements and accreditation standards, preferred.

Current CO RN License

Position Duties (essential functions denoted with an * )

Reviews & analyzes information relative to admission in accordance with Centura policy and documents assessment using case management software and/or other clinical information system.*

Assesses patient’s physical, psychosocial, cultural and spiritual needs through observation, interview, review of records and interfacing with patient, physician and interdisciplinary team and caregivers to assist patient/family in making decisions toward next level of care.*

 Facilitates discharge planning using case management software, working with patients, families and treatment team making any needed referrals/arrangements and documenting actions.*

 Participates in the Performance Improvement process through concurrent chart review and participation on clinical effectiveness teams. *

 Documents CM actions taken in EMR.*

 Confirms treatment goals and anticipated plan of care through discussions with treatment team/review of documentation. *

 Utilizes tools such as guidelines, criteria, or clinical pathways to assist in facilitating plan of care and appropriateness.*

 Communicates treatment goals or best practices to treatment team including physician using established criteria/guidelines.*

 Assess, coordinates and evaluates use of resources and services relative to plan of care and discusses variances on an as-needed basis with treatment team.*

 Communicates modifications in plan of care to treatment team and any needs for further documentation.*

 Facilitates family conference meetings on an as-needed basis and documents outcome.*

 Participates and/or leads interdisciplinary rounds to facilitate plan of care and discharge.*

 Reviews variance in Plan of Care with CM Director/Manager as needed.*

 Interfaces closely with Social Worker, Homecare Coordinator, Ambulatory Care Case Manager, Disease Manager, and Utilization Reviewer to ensure seamless and timely delivery of services and avoid unnecessary delays in discharge.*

 Maintains updated referral resource lists.*

 Identifies when variances occur in anticipated plan of care, tracks for process improvement, and refers to CMO or PA or Third Party Reviewer for peer review as needed.*

 Tracks avoidable days using case management software.*

 Able to identify and apply evidence based criteria/regulatory guidelines for accuracy in establishing appropriate patient status and level of care. Applies medically necessary validation and may enlist physician advisor and/or Third Party Reviewer.*

 Involved with identifying LOS and projected discharge date early in admission and communicate this to the care team.*

 Works with third party payers to satisfy utilization review requests and obtain approval of stays.*

 Participates in providing information on outliers for length of stay and recommending proactive solutions.* Participates in denial management with CM Manager/Director with clinical information for denial reversals.*

 Performs utilization review in accordance with UM Plan to include concurrent/retro reviews and verify admission/bed status.*

 Proactive management of factors influencing length of stay using critical thinking skills minimizing variance days.*

 Proactive monitoring of appropriate patient status with interaction with physician for to assure correct order early in admission.*

* This job description is not intended to be an exhaustive list of all duties. Employee may perform other related duties as assigned.

Physical Requirements

☑ Medium Work - exert/lift up to 50 lbs. force occasionally, and/or up to 20 lbs. frequently, and/or up to 10 lbs. constantly

**The UR RN will review medicare cases/private insurance- inpatient and observation- extended recovery status- insurance tasks and denials- -These RN’s review charts to ensure we are in compliance with Status Determination by using MCG. They have the option to work from home. Full Time days-the hours are flexible. Most start by 7-7:30am. Would like a RN with UR experience - Must live in Colorado

Important notification to applicants as of Nov. 20, 2014: Effective Jan. 1, 2015, Centura Health will no longer hire tobacco users in Colorado and Kansas. The change to our policy does not apply to associates hired on or before Dec. 31, 2014. Centura Health is an Equal Opportunity Employer, M/F/D/V.

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