Referral Clinical Review RN
Company: UCHealth
Location: Lakewood
Posted on: January 15, 2021
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Job Description:
Job DescriptionSummary: Establishes medical necessity for
advanced services and procedures. Liaisons with providers, payers,
and others to facilitate navigation of complex authorization and
reimbursement processes. Work Schedule: Full Time Days
Responsibilities: Reviews clinical documentation and guidelines for
pending referrals, calling when necessary in an attempt to obtain
authorization, mitigating the need for physician calls. Facilitates
peer-to-peer reviews as needed. Identifies documentation requiring
clarification, communicating with providers or other healthcare
professionals to ensure medical necessity is supported. Serves as a
resource to providers and other healthcare professionals regarding
appropriateness of clinical documentation. Determines that medical
necessity documentation and intent is established to meet Medicare
compliance for diagnosis codes entered by providers. Changes
diagnosis codes and documents details in EMR as needed. Initiates
complex referrals on authorization portals, and trouble-shoots how
best to navigate portals to obtain authorizations upon submission.
Withinscope of job, requires critical thinking skills, decisive
judgement and theability to work with minimal supervision. Must be
able to work in afast-paced environment and take appropriate
action. Requirements: * Credentials: Essential: * Registered Nurse
* Other information: Minimum Required Education: Bachelor's degree
in Nursing from an accredited Registered/Professional Nursing
program. Required Licensure/Certification: State licensure as a
Registered Nurse (RN). Minimum Experience: 3 years of experience as
an RN. * IF APPLICABLE: BLSthrough the American Heart Association
or the American Red Cross CPR for theProfessional Rescuer with card
in-hand before start date. BLS or CPRcard must be good through
sixty days of hire. All life supportcertification cards must be
issued by either the American Heart Association orthe American Red
Cross CPR for the Professional Rescuer. (American Red Crossfor the
Professional Rescuer is only good upon hire and all renewals will
needto be through an American Heart Association sanctioned course.)
IFAPPLICABLE: Are you a RN NewGrad? Visit tofind out about our
exciting New Grad opportunities! This position's pay range starts
at: $31.230000/hour. An annual bonus may be paid to eligible
employees based upon organizational and individual performance. At
UCHealth, we do things differently Webelieve in something
different: a focus on the individuality of every big ways and
small, we exist to improve the extraordinary lives of all thosewe
serve. As Colorado's largest and most innovative healthcare system,
we as a team deliver on the commitment to provide the bestpossible
experience for our patients and their families. We foster a true
humanconnection and give people the freedom to live extraordinary
lives. A career atUCHealth is more than a job, it's a passion.
Goingbeyond quality requires the perfect balance of talent,
integrity, drive andintellectual curiosity. We are looking for
individuals who recognize, like us,that the world of medicine is
ever-changing and are motivated to do what isright, not what is
easy. We support creativity and curiosity so thateach of us can
find the extraordinary qualities within ourselves. At
UCHealth,we'll do everything in our power to make sure you grow and
have a meaningfulcareer. There's no limits to your potential here.
Be Extraordinary. Join Us Today! UCHealthrecognizes and appreciates
the rich array of talents and perspectives thatequal employment and
diversity can offer our institution. As anaffirmative action/equal
opportunity employer, UCHealth is committed to makingall employment
decisions based on valid requirements. No applicantshall be
discriminated against in any terms, conditions or privileges
ofemployment or otherwise be discriminated against because of the
individual'srace, creed, color, religion, gender, national origin
or ancestry, age, mentalor physical disability, sexual orientation,
gender identity, transgenderstatus, genetic information or veteran
status. UCHealth does notdiscriminate against any "qualified
applicant with a disability" as definedunder the Americans with
Disabilities Act and will make reasonableaccommodations, when they
do not impose an undue hardship on the organization.
Keywords: UCHealth, Denver , Referral Clinical Review RN, Healthcare , Lakewood, Colorado
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