You bring your body, mind, heart and spirit to your work as a Utilization Review Registered Nurse.
Your compassion is tangible: patients feel it in the hand they hold. Families feel it in your prayers. Colleagues feel it in your support.
Youâ™re equally comfortable with integrated case management, working independently, and working with an interdisciplinary team.
Youâ™re great at what you do, but you want to be part of something even greater. Because you believe that while individuals can be strong, the right team is invincible.
St. Maryâ™s Medical Center is part of SCL Health, a faith-based, nonprofit healthcare organization that focuses on person-centered care. Our 346-bed regional medical center is in Grand Junction, one of the most beautiful places on earth. Our mission is to bring health and hope to the poor, the vulnerable, our communities and each other.
Benefits are one of the ways we encourage health for you and your family. Our generous package includes medical, dental and vision coverage. But health is more than a well-working body: it encompasses body, mind and social well-being. To that end, weâ™ve launched a Healthy Living program to address your holistic health. Healthy Living includes financial incentives, digital tools, tobacco cessation, classes, counseling and paid time off. We also offer financial wellness tools and retirement planning.
Together weâ™ll align mission and careers, values and workplace. Weâ™ll encourage joy and take pride in our integrity.
Weâ™ll laugh at each otherâ™s jokes (even the bad ones). Weâ™ll hello and high five. Weâ™ll celebrate milestones and acknowledge the value of spirituality in healing.
Weâ™re proud of what we know, which includes how much there is to learn.
As a Utilization Review RN you need to know how to:
Use nationally recognized review criteria to ensure that patient status is at the appropriate level of care. Collaborate with physicians and care managers to support an appropriate and timely patient discharge.
Understand CMS medical necessity requirements and the coordination of care required under Federal and State regulations.
Perform initial review and authorizations for admission. Perform concurrent reviews to ensure that extended stays are medically necessary and justification is documented in the medical record. Perform ongoing review of precertification and retrospective review for medical necessity. Participate in continued stay reviews. Communicate with attending physician regarding questions about continued length of stay, plan of care/discharge, and physician orders.
Refer appropriate cases to the designated Physician Advisor in accordance with established guidelines for admission status or continued stay.
Collaborate with case managers, physicians, and payers related to status, coverage, benefits, and discharge planning as needed.
Review medical records and prepare for appropriate clinical appeals.
Identify opportunities for physician education regarding length of stay, resource utilization and clinical documentation related to justification for hospital services.
Work with multidisciplinary team to assess and improve denial management, documentation, and appeals process.
Document all UR interventions in appropriate electronic record.
We hire people, not resumes. But we also expect excellence, which is why we require:
Graduate of an accredited school of nursing (Bachelorâ™s Degree in Nursing (BSN) may be required for some care sites)
Current Colorado RN license or compact license with the ability to obtain Colorado RN license
Minimum of three (3) years of case management experience
Demonstrated knowledge of medical terminology and desktop software, including Microsoft Office
Bachelorâ™s Degree in Nursing (BSN) (BSN may be the minimum requirement at some care sites)
At least five (5) years of nursing experience
Your next move.
Now that you know more about being a Utilization Review RNÂ on our team we hope youâ™ll join us. At SCL Health youâ™ll reaffirm every day how much you love this work, and why you were called to it in the first place.
SCL Health is a faith-based, nonprofit healthcare organization dedicated to improving the health of the people and communities we serve, especially those who are poor and vulnerable. Founded by the Sisters of Charity of Leavenworth in 1864, our $2.8 billion health network provides comprehensive, coordinated care through eight hospitals, more than 150 physician clinics, and home health, hospice, mental health and safety-net services primarily in Colorado and Montana.