Doyou have a passion for healthcare and helping others? Do you enjoy working in afast-paced, patient-centered environment? Jump-start your career as a RN Utilization Review position with HCAContinental Division. Submit your application today!
We offer you an excellent total compensation package, including competitive salary, excellent benefit package and growth opportunities. We believe in our team and your ability to do excellent work with us. Your benefits include 401k, PTO, medical, dental, flex spending, life, disability, tuition reimbursement, employee discount program, employee stock purchase program and student loan repayment. We would love to talk to you about this fantastic opportunity.
Leading Hospitals. TrustedCare.
HealthONE® is thelargest healthcare system in the metro Denver area with more than 10,000employees. As part of the HealthONE family, The Medical Center of Aurora, NorthSuburban Medical Center, Presbyterian/St. Luke’s Medical Center, Rocky MountainHospital for Children, Rose Medical Center, Sky Ridge Medical Center, SwedishMedical Center, and Spalding Rehabilitation Hospital work together to provide ahigher level of care.
In addition, our family ofservices includes six hospital free-standing emergency departments and numerousambulatory surgery centers, occupational medicine clinics, physician practices,imaging centers, and AIRLIFE-DENVER, which provides critical care air andground transportation across a 10-state region.
The Medical Center of Aurora: Magnet® designated hospital, Level II TraumaCenter, 346 licensed beds
North Suburban Medical Center: Level III Trauma Center, 157 licensed beds
Presbyterian/St. Luke’s Medical Center & RockyMountain Hospital for Children: LevelII Trauma Center, 680 licensed beds
Rose Medical Center: Magnet® designated hospital, Level II Trauma, 422 licensedbeds
Sky Ridge Medical Center: Level II Trauma, 274 licensed beds
Swedish Medical Center: Level I Trauma, 408 licensed beds
Behavioral Health and Wellness Center at the MedicalCenter of Aurora: 120 licensed beds
The Utilization Review RN provides clinical information to insurancecompanies according to the terms of the contract, receive/seek outauthorization/certification for the hospital stay, perform concurrent denials,determine the correct patient status by reviewing medical necessity and communicatethis to the facilities, follow the X-code process per HCA policy and maintaincommunication with the facility case managers.
DUTIES INCLUDE BUT ARE NOT LIMITED TO:
This position will focus on initial and continued stay utilization reviewand denials to include assessment of medical records for appropriateness aswell as level of care provided. A teamapproach with the facility Case Management department is essential.
Perform InterQual review within one business day on all inpatient admissions.(Excluding FC 1, 2, 15, 99 (Medicare, self-pay, uninsured/charity) &Mother/Well-Baby).
Document note to support inpatient admission.
Review for inpatient admission status order.
Ensure the patient’s status is correct in Meditech & MIDAS.
Perform continued stay reviews via InterQual application, at a minimum ofevery 3 days.
Review concurrent denials and work with the facility and physician tooverturn.
Communicate the denial status to the facility and physician.
Follow all HCA standards regarding documentation and education.
Communicate with physicians regarding patient status.
Communicate medical necessity and responder criteria to the facility casemanagers.
Review the Authorization/Certification report daily to determinedeficiencies.
Documentation to take place in Midas within the Care Enhancement ReviewEntry (CERME), Midas Certification Entry, Midas Concurrent Review Entry and theAvoidable/Denied Days Module.
Ifyou are looking for an opportunity that provides satisfaction and personalgrowth, we encourage you to apply. We promptly review all applications. If youare highly qualified you will hear from one of our managers. Come unlock thepossibilities and apply today!
We are an equal opportunity employer and valuediversity at our company. We do not discriminate on the basis of race,religion, color, national origin, gender, sexual orientation, age, maritalstatus, veteran status, or disability status.
BSN, Bachelor of Science in Nursing(preferred)
Registered Nurse (RN)
Acute care hospital case management/utilization review experience
Third party payer experience (helpful)
Denials Management (helpful)
Our Company’s recruiters are here to help unlock the next possibility within your career and we take your candidate experience very seriously. During the recruitment process, no recruiter or employee will request financial or personal information (Social Security Number, credit card or bank information, etc.) from you via email. The recruiters will not email you from a public webmail client like Gmail or Yahoo Mail. If you feel suspicious of a job posting or job-related email, let us know by clicking here.
For questions about your job application or this site please contact HCAhrAnswers at 1-844-422-5627 option 1.
Join our HealthONE family -- the largest healthcare system in the Denver metro area. Eight world-class hospitals. 40+ outpatient facilities. Countless opportunities.HealthONE is an equal opportunity employer.