Utilization Management RN

Job Description

Location: UCHealth UCHlth Admin 2450 Peoria, US:

CO:

Aurora

Department: UCHlth Patient Line Referrals

Work Schedule: Full Time, 64.00 hours per pay period (2 weeks)

Shift: Days

Pay: $38.91 - $60.31 / hour. Pay is dependent on applicant's relevant experience

Ensures that services are delivered and documented in a manner that balances quality of care with efficiency, cost-containment and compliance.

• Reviews admissions and service requests within assigned unit for prospective, concurrent, and retrospective medical necessity and/or compliance with reimbursement policy criteria.
• Provides case management and/or consultation for complex cases.
• Assists departmental staff with issues related to Milliman (or similar) guidelines, status determination, medical records/documentation, precertification, reimbursement and concurrent denials appeals.
• Collaborates closely with case managers to make sure status and level of care are accurate.
• Communicates with payers as needed to ensure patient accounts are secured.
• Assesses and coordinates patient's discharge planning needs with members of the healthcare team.
• Requires critical thinking skills, decisive judgement, and the ability to work with minimal supervision.
• Must be able to work in a fast‑paced environment and take appropriate action.

• Bachelor's degree in Nursing.
• State licensure as a Registered Nurse (RN).
• 3 years of relevant experience. Preferred: 3 years of utilization or case management experience.
• BLS through the American Heart Association or the American Red Cross CPR for the Professional Rescuer with card in‑hand before start date. BLS or CPR card must be good through sixty days of hire.

• Performance bonus: UCHealth offers a 3-Year Incentive Bonus to recognize employee contributions to our success in quality, patient experience, organizational growth, financial goals and tenure. The bonus accumulates annually each October and is paid out in October during the third year of employment.
• Performance‑based pay increase:
  The Annual Merit Pay Increase recognizes work performance that meets or consistently exceeds performance standards documented through UCHealth's established evaluation process and accounts for increased experience, skills and cost of living.
• Market reviews:
  All UCHealth positions are reviewed annually to ensure UCHealth base pay aligns with market standards. Base pay rates are adjusted as needed to stay market competitive.

• Medical, dental and vision coverage.
• Access to 24/7 mental health and well‑being support for employees and dependents.
• Discounted gym memberships and fitness resources.
• Free  membership.
• Voluntary benefits such as accident insurance, critical illness insurance, group legal plan, identity theft protection, pet insurance, auto and home insurance, and employee discount programs.
• Paid time off (PTO), paid family and medical leave (inclusive of Colorado FAMLI), leaves of absence.
• Employer-provided basic life and accidental death and dismemberment coverage with buy‑up coverage options.
• Employer-provided short‑term disability and long‑term disability with a buy‑up coverage option.

• 403(b) plan with employer matching contribution.
• Additional 457(b) plan may be available.
• Flexible spending accounts for health care and dependent day care; health savings account available when enrolled in high‑deductible (HD) medical plan.

• UCHealth provides access to academic degrees and certificate programs to promote professional and personal growth.
• Up to 100% of tuition, books and fees paid for by UCHealth for specific educational degrees.
• Other programs may qualify for up to $10,000/year pre‑paid by UCHealth or up to $5,250/year in the form of tuition reimbursement.
• Access to Linked In Learning, which offers thousands of virtual courses and seminars, and internal professional development opportunities.
• Employees have access to free assistance navigating the Public Service Loan Forgiveness program and submitting their federal student loans for forgiveness.

UCHealth recognizes and appreciates the rich array of talents and perspectives…