Utilization Review Coordinator

BASIC FUNCTION: The Utilization Review (UR) Specialist has well-developed knowledge and skills in areas of utilization management (UM), medical necessity, and patient status determination for Inpatient, observation, and Swing Bed. This individual supports the UM program by developing and/or maintaining effective and efficient processes for determining the appropriate admission status based on the regulatory and reimbursement requirements of various commercial and government payers.

RESPONSIBILITIES:

• Performing a variety of concurrent and retrospective UM-related reviews and functions and for ensuring that appropriate data is tracked, evaluated, and reported.
• Monitors the effectiveness/outcomes of the UM program, identifying and applying appropriate metrics, evaluating the data, reporting results to various audiences, and designing and implementing process improvement projects as needed.
• Identifies, develops, and provides orientation, training, and competency development for appropriate staff and colleagues on an ongoing basis.
• Leads and/or actively participates in process improvement initiatives, working with a variety of departments and multi-disciplinary staff. T
• Maintains current and accurate knowledge regarding commercial and government payers and regulations/guidelines/criteria related to UM.
• Ensuring that the UM program maintains documented, up-to-date policies and procedures and ensures and that all UM key processes have valid outcome measures that are monitored for compliance and reported to a variety of audiences. T
• Effectively and efficiently manages a diverse workload in a fast-paced, rapidly-changing regulatory environment. T
• Facilitates the hospital’s UR Committee with UR Medical Provider member.
• Performs a variety of tasks and other duties as assigned.

QUALIFICATIONS:

• Graduation from an accredited school of Nursing.
• Active license in the State of Colorado as Registered Nurse. A temporary permit issued by the Board of Nursing
• Must have current BLS card upon hire and maintain current certification status throughout GRHD employment.
• Bachelor’s Degree preferred.
• ACM, CCM, Board Certification in Nursing Case Management, CPHQ preferred.
• 5 years overall nursing experience required.
• Recent experience as an inpatient utilization review nurse or UM coordinator preferred.

SALARY INFORMATION:

• $30.00 - $45.00 Dependent on experience may vary outside this range
• Compensation may vary outside this range depending on a number of factors, including a candidate’s qualifications, skills, competencies and experience

Position is open until filled unless posted otherwise

BENEFITS:

This position offers competitive pay, being part of a very cohesive & supportive team, and year round recreation with everything the outdoor enthusiast can imagine. Our comprehensive benefits package includes:

• Medical, with prescription drug coverage
• Vision and dental insurance
• Medical and dependent care flexible spending accounts
• PTO accrual from day one
• Extended illness benefits/time off
• 457 retirement plan with match
• Life and accidental death and dismemberment insurance, disability, employee assistant programs, AFLAC, identity theft protection and pet insurance.

Clinical Excellence. Patient & Community Satisfaction. Financial Health & Stewardship of Resources.

These are our three Keys to Excellence; and we are looking for the BEST around to join us as we demonstrate those values Every. Single. Day

Grand River Health proudly serves residents of Western Colorado and beyond. We are a not-for-profit Special Tax District, formed by the citizens of Western Garfield County in 1961 to serve the area’s health care needs. Our main hospital campus is located in the picturesque Rifle, Colorado with twenty-five beds providing a wide range of services, along with a long-term care center and a satellite campus. While the secret is out that this is a great place to live, the atmosphere of a caring and friendly community has been preserved amidst a steady growth of population.

OUR MISSION:

To improve the health and well-being of the communities we serve.

OUR VISION:

To be our communities’ first choice in quality healthcare.