RN Utilization Review

RN Utilization Review * SIgn-On Bonus Housing Stipend for FT Perm*

Life-in-the-mountains, perks of a full-time position with Middle Park Health, a Critical Access Hospital, Level IV Trauma Center:
Middle Park Health (MPH) is a successful rural health system located in the high Rockies 1 1/2 hour west of Denver, CO with seven locations in beautiful Grand and Jackson counties where we have an abundance of year-round outdoor recreational activities. As a Level 4 Trauma hospital, MPH provides a range of services, including Emergency and Surgical Services, Rural Health Clinics, Rehabilitation Services Clinics, a Wellness Center, and an Assisted Living Facility. We are in the process of constructing a new medical center in Fraser, with plans for completion in spring, 2025.

About the Role:

As an RN Utilization Review, you will play a crucial role in ensuring the efficient and effective use of healthcare resources. Your main responsibility will be to review and evaluate the medical necessity and appropriateness of healthcare services provided to patients. By conducting thorough assessments and analyzing medical records, you will determine the most appropriate level of care and treatment for each patient. Your expertise will contribute to the overall quality of patient care and help optimize healthcare outcomes. This role requires strong critical thinking skills, attention to detail, and the ability to work collaboratively with healthcare professionals and insurance providers.

Minimum Qualifications:

• Valid Registered Nurse (RN) license in the state of Colorado.
• Bachelor's degree in Nursing or related field.
• Proven experience in utilization review or a related healthcare field.
• Strong knowledge of medical terminology, healthcare regulations, and reimbursement systems.
• Excellent analytical and critical thinking skills.

Preferred Qualifications:

• Certification in Utilization Review or Case Management.
• Experience with electronic health record systems.
• Knowledge of Medicare and Medicaid guidelines.
• Ability to interpret and apply clinical guidelines and evidence-based practices.
• Effective communication and interpersonal skills.

Responsibilities:

• Conduct comprehensive reviews of medical records to assess the medical necessity and appropriateness of healthcare services.
• Analyze patient information, including diagnoses, treatment plans, and outcomes, to determine the most appropriate level of care.
• Collaborate with healthcare professionals, insurance providers, and other stakeholders to ensure the coordination and continuity of care.
• Document findings and recommendations in a clear and concise manner, adhering to regulatory and organizational guidelines.
• Participate in quality improvement initiatives and provide feedback to enhance the utilization review process.

Status: Full-Time

Location: Kremmling, CO based

Compensation: $38.00 - $64.00per hour DOE $10,000 Sign-on and $350/mo Housing Stipend for FT Perm. Stipend requires residence in Grand, Jackson or Summit county.

Benefits available include Health, Vision, Dental, FSA or HSA, STD LTD, AFLAC, Retirement with Match, Wellness and more

Middle Park Health does not discriminate because of race, color, creed, age, sex, marital status, religion, disability, national origin, veteran’s status or any other federal or state protected status.