What are the responsibilities and job description for the Utilization Review RN, PRN position at Gunnison Valley Health?
The UR R.N. is responsible for the daily continuity of patient care and effective utilization of health care services through case management, discharge planning, and patient education in compliance with all federal and state regulations and payer requirements. Works with a multidisciplinary team of clinical and non-clinical providers and staff to ensure the patient is receiving the highest quality of care in the appropriate setting.
Education: Graduation from an accredited School of Nursing. BSN preferred
Experience: Requires the ability to understand medical record documentation for all clinical disciplines. Experience with CDM preferred.
Licenses/Certifications: Current Colorado RN license in good standing.
- Observes professional ethics in maintaining confidential information concerning the personal, financial, medical, or employment status of a patient of GVH and their families.
- Concurrently analyzes all inpatient, observation, and outpatient in a bed cases for medical necessity of continued stay and provides feedback to providers for required supporting documentation as necessary per Federal, State, and commercial payer guidelines.
- Provides daily consultation to professional staff and employees regarding patient stay options, financial considerations, psychosocial concerns, risk management, and ethical issues for all patients who are in-house.
- Communicates with insurance companies on a daily basis by ensuring that precertification requirements for each payer are met by providing treatment plans and medical records, updates to patient status are completed, and that authorization numbers are obtained as required.
- Maintains and updates the observation hours and outpatient in a bed hours logs on a daily basis.
- Communicates interdepartmentally to integrate UR activities into the revenue cycle.
Compensation: $37.17 - $47.08/hour DOE
Salary : $37 - $47
