Remote Utilization Review Nurse (RN) – Colorado

Job Overview

  • Clinical License RN
  • State(s) CO

Full job description

Remote Work:This position is eligible to work remotely as approved by management

 


Position qualifications:

Graduate from an accredited school of Nursing and licensed as a Registered Nurse in the State of Colorado. Two (2) years previous experience in a psychiatric hospital or other psychiatric setting preferred. Experience in utilization review with insurance companies/payers preferred. Background in an inpatient, emergency room, or family practice setting desirable.

 


Job purpose:

Perform concurrent reviews to justify continued hospitalization, ensuring all services will be reimbursed and the quality of services provided align with organizational standards and applicable regulations for inpatient psychiatric hospitals.

Knowledge, Skill & Ability(include materials and equipment directly used):

  • CPR/BLS Certification for Healthcare Provider optional.
  • Verbal De-Escalation/Certification optional in order to perform duties required to provide verbal de-escalation and physical and mechanical restraints if necessary (Training for certification will be provided).
  • Ability to accurately collect and analyze data and report on significant utilization trends and identify areas for improvement.
  • Ability to review chart content, screening for rationale to justify hospitalization.
  • Working knowledge of psychiatric medications, their efficacy, rationale for medications
  • Ability to assess individual’s potential for dangerousness to self, to others and/or grave disability.
  • Ability to collaborate and communicate successfully with hospital staff and external customers.
  • Ability to work closely with treatment team and providers to obtain necessary clinical information.
  • Ability to advocate for patients and their right to receive care which is reimbursed for appropriately.
  • Ability to appropriately and immediately document interactions with patients and potential patients.
  • Maintain the confidentiality of all patient information per HIPAA regulations, federal and state law, and facility policies and procedures.
  • Working knowledge of Windows based computer applications to include Microsoft Word, Microsoft Excel, Microsoft Outlook, and Internet access.
  • Ability to operate standard office equipment including calculator, copy machine, fax and multi-line telephone.
  • Interpersonal and communication skills to develop and maintain effective working relationships with all internal and external customers.
  • Ability to organize and prioritize workload in a sometimes hectic environment with frequent interruptions.

 


Working Conditions/Physical Demands:

Employee must occasionally lift and/or move up to 25 pounds. Employee is frequently required to walk, sit, stand, or kneel and occasionally required to climb or balance, and stoop. Must have the ability to sit for longer periods of time at a computer. Employee must be able to travel between Mind Springs sites. May be exposed to stressful situations that involve enraged, distraught, and/or intoxicated individuals with possible mental health conditions. Possible exposure to communicable disease. The noise level in the work environment is usually moderate. Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions.

 

 

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