Utilization Review RN
Partnering for a stronger, healthier world.
At CommonSpirit Health, we believe in the healing power of humanity. We invite you to explore our specialty areas and pursue a career in humankindness.
- Employment Type: Full Time
- Department: Utilization Review
- Hours/Pay Period: 80
The posted compensation range of $28.94 - $41.97 /hour is a reasonable estimate that extends from the lowest to the highest pay CommonSpirit in good faith believes it might pay for this particular job, based on the circumstances at the time of posting. CommonSpirit may ultimately pay more or less than the posted range as permitted by law.
Job Details
Utilization Review RN is responsible for the review of medical records for appropriate admission status and continued hospitalization. Works in collaboration with the attending physician, consultants, second level physician reviewer and the Care Coordination staff utilizing evidence-based guidelines and critical thinking. Collaborates with the Concurrent Denial RNs to determine the root cause of denials and implement denial prevention strategies. Collaborates with Patient Access to establish and
verify the correct payer source for patient stays and documents the interactions. Obtains inpatient authorization or provides clinical guidance to Payer Communications staff to support communication with the insurance providers to obtain admission and continued stay authorizations as required within the market.
Responsibilities
Qualifications
Graduate of an accredited school of nursing. RN license in the state(s) covered is required.
Minimum two (2) years of acute hospital clinical experience or a Masters degree in Case Management or Nursing field in lieu of 1 year experience.
BLS required within 3 months of hiring if located within hospital
Ability to pass annual Inter-rater reliability test for Utilization Review product(s) used.
Preferred
Certified Case Manager (CCM), Accredited Case Manager (ACM-RN), or UM Certification
Proficient in application of clinical guidelines (MCG/InterQual) preferred
Knowledge of managed care and payer environment preferred.
Must have critical thinking and problem-solving skills.
Collaborate effectively with multiple stakeholders
Professional communication skills.
Understand how utilization management and case management programs integrate.
Ability to work as a team player and assist other members of the team where needed.
Thrive in a fast paced, self-directed environment.
Knowledge of CMS standards and requirements.
Proficient in prioritizing work and delegating where indicated.
Highly organized with excellent time management skills.
Nursing excellence
starts with you.
Are you a career fit with our CommonSpirit Health culture? To understand how we are structured, we believe in some core philosophies with the following:
We will be stronger together, achieving excellence in all we do, collaborating across the fields and growing our collective knowledge.
We will let humankindness guide us as we treat every person with holistic, personalized care for the body, mind and spirit.
We will advance the science and art of nursing as innovative leaders who demonstrate the power of evidence-based, compassionate care. If you believe in working together with humankindness for all to advance the science and art of nursing - then you have found your career fit with us!
“Our hope is that you will always feel inspired, knowing you truly are the heart and soul of CommonSpirit.”
– Kathleen D. Sanford, EVP, Chief Nursing Officer
Your Potential Career Path
This is a snapshot of your potential career path highlights the series of job positions that help you progress towards your goals and objectives. Ultimately, your career path depends on your career values and personal goals.
While you’re busy impacting the healthcare industry, we’ll take care of you with benefits that may include health/dental/vision, FSA, matching retirement plans, paid time off, tuition assistance, adoption assistance, and more!
Unless directed by a Collective Bargaining Agreement, applications for this position will be considered on a rolling basis. CommonSpirit Health cannot anticipate the date by which a successful candidate may be identified.
Success Profile
What makes a successful Utilization Review RN at CHI Health?
- Compassionate
- Trustworthy
- Proactive
- Collaborative
- Communicator
- Balanced
Our Total Reward Offerings
At CommonSpirit Health, we believe investing in our employees lets them know they truly matter. Your Total Rewards package includes compensation, benefits, retirement, wellness, leave, and other programs.
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Pay and Recognition
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Balanced Life
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Well-Being
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Professional Growth
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Financial Future
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Dependent Care
While you’re busy impacting the healthcare industry, we’ll take care of you with benefits that may include health/dental/vision, FSA, matching retirement plans, paid time off, tuition assistance, adoption assistance, and more!
Unless directed by a Collective Bargaining Agreement, applications for this position will be considered on a rolling basis. CommonSpirit Health cannot anticipate the date by which a successful candidate may be identified.
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