We are recruiting for a Registered Nurse, Utilization Coordinator to joinour team!

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　　DepartmentHospital Care Mgmt

　　Job Summary

　　Under general supervision, the RN Utilization Review Coordinator willfacilitate the appropriate status and level of care. This includes allcommercial insurance, Medicare, Medicaid and self-pay. These will bereviewed on a cadence defined in the specific workflow. All Reviews will bedone to ensure compliance with all state, federal and third-party payors.They will communicate daily and as needed to the RN Care Coordinator,Clinical Social Worker and healthcare teams.

　　Essential Functions:

　　Status and Level of Care Management* Manages observation status patients to determine appropriateness fordischarge or conversion to inpatient admission using approved medicalnecessity criteria continually throughout the observation stay* Conducts medical necessity reviews on all inpatient admissions, transfersand continued stay patients using approved medical necessity criteria daily* Initiates Condition Code 44 process when applicable* Works with the Clinical Documentation Improvement Specialists andphysicians to identify opportunities to improve the accuracy of thedocumentation as well as identify the working MSDRG and associated geometricmean length of stay* Conducts proactive medical necessity review of cases being referred fromthe Emergency Room, PACU, transfers and direct admissions from physicianoffices to ensure appropriate status and level of care placement , as assigned* Uses the criteria software application to document results of criteriaapplication according to the documentation policy, i.e. MCG criteriaapplication, length of stay assignments and variance documentation, etc.* Initiates Physician Advisor referrals for any cases not meeting criteriafor the level of care* Ensures compliance with all state, federal and payor medical necessityand certification requirements(40%)Utilization Review for Insurance Companies* Documents clinical information as required for insurance companycertification according to required payor timeframe standards* Works collaboratively with the Clerical Support Staff to ensure allinsurance reviews are received by the insurance company and a dispositionresponse is received* Documents all insurance certification activities in the assigned locationsaccording to the department documentation standards(40%)Compliance* Ensures compliance with all applicable state and federal regulatoryrequirements as well as the insurance company rules such as Patient Choice,Important Message from Medicare #2, Condition Code 44, insurancecertification processes, etc.* Maintains compliance with established hospital policies,procedures, objectives, safety, environmental and infection controlguideline* Protects Patient Rights as they pertain to the ethical and legal issues ofconfidentiality during the case management process(20%)Education:

　　Associate's Degree Completion of a nursing education program that satisfiedthe licensing requirements of the Colorado State Board of Nursing forRegistered Nurses. RequiredWork Experience:

　　1-3 years Three years clinical experience in a hospital, acute care, homehealth/hospice, direct care or case management required. RequiredLicenses:

　　RN-Registered Nurse - DORA - Department of Regulatory Agencies RequiredKnowledge, Skills and Abilities:

　　Bilingual in English/Spanish preferred.Knowledge and understanding of case management/coordination of careprinciples, programs, and processes in either a hospital or outpatienthealthcare environment.Effectively collaborate with and respond to varied personalities in differingemotional conditions, and maintain professional composure at all times.Strong customer service orientation and aptitude.Problem solving skills; the ability to systematically analyze problems,draw relevant conclusions and devise appropriate courses of action.Ability to communicate verbally and in writing complex or technicalinformation in a manner that others can understand, as well as ability tounderstand and interpret complex information from others.Microsoft Office Suite required.Experience with windows-based computer programs and ability to use computerfor data analysis and data display required.Prefer experience with Medical Management platforms used to document carecoordination services.

　　ShiftDays (United... For full info follow application link.