DescriptionSHIFT: No Weekends
The Utilization Review RN provides clinical information to insurance companies according to the terms of the contract, receive/seek out authorization/certification for the hospital stay, perform concurrent denials, determine the correct patient status by reviewing medical necessity and communicate this to the facilities, follow the X-code process per HCA policy and maintain communication with the facility case managers.
This position will focus on initial and continued stay utilization review and denials to include assessment of medical records for appropriateness as well as level of care provided. A team approach with the facility Case Management department is essential.
HealthONE® is the largest healthcare system in the metro Denver area with more than 10,000 employees. As part of the HealthONE family, The Medical Center of Aurora, North Suburban Medical Center, Presbyterian/St. Luke’s Medical Center, Rocky Mountain Hospital for Children, Rose Medical Center, Sky Ridge Medical Center, Swedish Medical Center, and Spalding Rehabilitation Hospital work together to provide a higher level of care. In addition, our family of services includes seven free-standing emergency departments, numerous ambulatory surgery centers, CareNow Urgent Care Clinics & Occupational Medicine, physician practices, and AIRLIFE-DENVER, which provides critical care air and ground transportation across a 10-state region.