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RN-Utilization Review, University Hospital

UofL Health • Full-time • Louisville, KY, US • 24m ago

Overview

We are Hiring at Jewish Hospital

Location: 530 S Jackson St, Louisville, KY 40202

Shift Options: Full Time, First

About Us

UofL Health is a fully integrated regional academic health system with nine hospitals, four medical centers, Brown Cancer Center, Eye Institute, nearly 200 physician practice locations, and more than 1,000 providers in Louisville and the surrounding counties, including southern Indiana. Additional access to UofL Health is provided through a partnership with Carroll County Memorial Hospital.

Affiliated with the University of Louisville School of Medicine, UofL Health is committed to providing patients with access to the most advanced care available. This includes clinical trials, collaboration on research and the development of new technologies to both save and improve lives. With more than 14,000 team members – physicians, surgeons, nurses, pharmacists and other highly-skilled health care professionals, UofL Health is focused on one mission: to transform the health of communities we serve through compassionate, innovative, patient-centered care. For more information on UofL Health, go to www.UofLHealth.org.

Our Mission

As an academic health care system, we will transform the health of the communities we serve through compassionate, innovative, patient-centered care.

Responsibilities

Under the direction of the Director, Care Coordination, the Utilization Review RN performs activities which support the Utilization Management functions. The Utilization Review RN is responsible for the delivery of the Utilization Management process not limited to and including: making clinical recommendations regarding medical necessity for admission and continues stay, screens patients for client specific guidelines regarding insurance, Medicare and/or Medicaid guidelines, send payor specific Notice of Admission and continued stay reviews. Communicates with physician and case managers regarding payor approval/denial of admission and continues stay review. Process payor denials and retro reviews. Promotes optimal health care outcomes in accordance with the policies, procedures, applicable laws and contracts, philosophy, mission and values of the University of Louisville Hospital; assumes responsibility and accountability for the appropriate utilization of facilities and services; serves as a resource to physicians; conducts admission and concurrent reviews including observation and inpatients; identifies patients who do not meet criteria and takes action to ensure patients are cared for in the most appropriate level of care; coordinates care in conjunction with other members of the interdisciplinary healthcare team to provide and facilitate optimal health and financial accountability. Utilizes the nursing process (assess, plan, implement and evaluate) and management process (plan, organize, direct and control) to provide a framework for decision-making; maintains confidentiality of information; actively supports organizational goals and objectives by providing needed information to divisions and departments.

Qualifications

Required Qualifications

Licensed or eligible for license in Kentucky
Basic Life Support (BLS) accredited by the American Heart Association (AHA)
BSN or RN with a Bachelors Degree in Business or Health Care Administration preferred. Will consider RN with ASN. if actively pursuing BSN, with BSN completion required within 2 years of hire.
Must have minimum three years’ experience as an RN plus minimum two years’ experience performing utilization review and/or quality assurance activities in an acute care facility or HMO/PPO/PRO preferred. Must be able to adjust priorities quickly, organize multiple tasks simultaneously, and work interdependently with many levels of staff. Attention to detail; strong organizational, interpersonal and communication skills; and innovative problem-solving skills required. Must be able to adjust work hours depending on depending upon departmental needs as determined by the director or manager.

Preferred Qualifications

ANCC Certification in a Nursing Case Management, ACM or CCM.

Benefits & Perks

Competitive Pay & Benefits Options
Paid Vacation, Sick days, and Holidays
Free tuition to UofL for Part- and Full-time employees for Child/Spouse/Domestic Partner
401K with Employer Match

#LI-DNI

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