RN Utilization Review, UofL Hospital, 3p-11p

Address

530 S Jackson St Louisville, KY 40202

Shift

Second Shift (United States of America)

Job Description Summary

UofL Health is a fully integrated regional academic health system with five hospitals, four medical centers, nearly 200 physician practice locations, more than 700 providers, the Frazier Rehab Institute and Brown Cancer Center.

With more than 12,000 team members—physicians, surgeons, nurses, pharmacists and other highly skilled health care professionals—UofL Health is focused on one mission: delivering patient-centered care to each and every patient each and every day.

Job Description

We are Hiring at Jewish Hospital

Location: 530 S Jackson St, Louisville, KY 40202

Shift Options: Full Time, Second

Our Mission

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

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. 

Additional Job Description

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