DenverRecruiter Since 2001
the smart solution for Denver jobs

Referral Clinical Review RN

Company: UCHealth
Location: Lakewood
Posted on: January 15, 2021

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

Click here to apply!

Didn't find what you're looking for? Search again!

I'm looking for
in category
within


Other Healthcare Jobs


RN Medical Oncology
Description: Welcome to Centura Health Welcome to Centura Health - the largest health ecosystem in Colorado and Kansas. Welcome to living your mission among thousands of people on fire to live theirs too. Welcome (more...)
Company: Centura Health
Location: Parker
Posted on: 01/28/2021

Radiation Therapist - PRN
Description: Welcome to Centura Health Welcome to the largest health ecosystem in Colorado and western Kansas. Welcome to living your mission among thousands of people on fire to live theirs too. Welcome to options, (more...)
Company: Centura Health
Location: Parker
Posted on: 01/28/2021

RN, Critical Care Specialties - HealthCare Traveler
Description: Critical Need for All Hospital Based RN SpecialtiesTravel Registered Nurse Jobs Assignments br Looking for an RN travel assignment You are in the right place, the HCEN Network of staffing agencies (more...)
Company: HealthCare Traveler Jobs
Location: Parker
Posted on: 01/28/2021


Bright Now Dental: Dental Hygienist - $2, 000 Sign On Bonus - Flex Schedule
Description: Job DescriptionCompany Overview: Smile Brands Weve made it our Smiles for Everyone mission to give patients the best possible dental experience, and we believe that starts with supporting our hardworking (more...)
Company: Bright Now Dental
Location: Parker
Posted on: 01/28/2021

Registered Nurse (RN)- GI Lab
Description: Welcome to Centura Health Welcome to Centura Health - the largest health ecosystem in Colorado and Kansas. Welcome to living your mission among thousands of people on fire to live theirs too. Welcome (more...)
Company: Centura Health
Location: Parker
Posted on: 01/28/2021

Bonus Available RN/Registered Nurse ICU
Description: Welcome to Centura Health Welcome to Centura Health - the largest health ecosystem in Colorado and Kansas. Welcome to living your mission among thousands of people on fire to live theirs too. Welcome (more...)
Company: Centura Health
Location: Parker
Posted on: 01/28/2021

Radiology Tech
Description: Welcome to Centura Health Welcome to the largest health ecosystem in Colorado and western Kansas. Welcome to living your mission among thousands of people on fire to live theirs too. Welcome to options, (more...)
Company: Centura Health
Location: Parker
Posted on: 01/28/2021

RN
Description: Welcome to Centura Health Welcome to Centura Health - the largest health ecosystem in Colorado and Kansas. Welcome to living your mission among thousands of people on fire to live theirs too. Welcome (more...)
Company: Centura Health
Location: Parker
Posted on: 01/28/2021

Registered Nurse (RN)- PACU- Part-time
Description: Welcome to Centura Health Welcome to Centura Health - the largest health ecosystem in Colorado and Kansas. Welcome to living your mission among thousands of people on fire to live theirs too. Welcome (more...)
Company: Centura Health
Location: Parker
Posted on: 01/28/2021

RN Medical Oncology
Description: Welcome to Centura Health Welcome to Centura Health - the largest health ecosystem in Colorado and Kansas. Welcome to living your mission among thousands of people on fire to live theirs too. Welcome (more...)
Company: Centura Health
Location: Parker
Posted on: 01/28/2021

Log In or Create An Account

Get the latest Colorado jobs by following @recnetCO on Twitter!

Denver RSS job feeds