Primary Location:

250 E Liberty St

Address:

250 East Liberty St. Louisville, KY 40202

Shift:

First 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:

        
The Utilization Review RN performs activities which support the Utilization Management functions.  They are responsible for the delivery of the Utilization Management process including but not limited to: 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.   The employee communicates with physician and case managers regarding payor approval/denial of admission and continues stay review. They process payor denials and retro reviews, promote optimal health care outcomes in accordance with the policies, procedures, applicable laws and contracts, philosophy, mission and values of UofL Health, assumes responsibility and accountability for the appropriate utilization of facilities and services and serves as a resource to physicians.  The employee 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.  This employee 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. 

Essential Functions:

5 days a week in office, no weekends, one holiday per year.

•    Promotes optimal management of clinical resources by conducting timely admission and concurrent utilization review for all patients of designated medical services; certifies medical necessity for admission, continued stay and discharge reviews for patients certified by utilizing the current MCG criteria; documents clinical information in Case Management Software system
•    During the concurrent review process, evaluates the medical record to identify any process delay impacting the timeliness of patient care in a collaborative effort to ensure that the appropriate resources are utilized (i.e. physical therapy, cardiac rehabilitation, or nutritional service)
•    Supports the utilization review program by maintaining effective and efficient processes for determining the appropriate admission status based on the regulatory and reimbursement requirements of various commercial and government payers
•    Communicates closely with third party payors to ensure all pertinent clinical information is provided to secure an authorization; appropriately documents information regarding the authorization number and the approved length of stay on the Case Manager Software
•    Advocates for patient/family needs in a respectful, non-judgmental, and confidential manner
•    Serves as a resource to physicians for clinical management and financial issues; assists the providers with promoting efficiencies in the care delivery system and reducing/ eliminating barriers to efficient/effective service.
•    Reviews patient cases for potential problems with OIG Workplan Audits and compliance issues; reports problems and makes recommendation to appropriate departments
•    Appropriately refers cases to manager/director of care coordination, CAO, or medical director when intensity of service or severity of illness is not present and is unable to resolved
•    Educates physicians, patients, and staff with regards to payors, financial issues, documentation, and potential compliance issues
•    Investigates and responds to billing concerns from Business Office, Health Information Management, Admitting, and other sources; resolves financial and billing problems, such as appropriate patient status, correct payor source, denials, appeals, and system issues
Other Functions:
•    Develops a cooperative, assistive relationship with third-party reviewers, working to facilitate timely, positive responses for patient accounts
•    Attends Monthly Departmental Staff Communications Meetings. Serves as an active member of committees, as needed, which may include a variety of projects or topics
•    Enhances professional growth and development through participation in educational programs, reading current literature, attending in-service meetings and workshops that are related to assigned areas of responsibility.
•    Maintains compliance with all company policies, procedures and standards of conduct
•    Complies with HIPAA privacy and security requirements to maintain confidentiality at all times
•    Performs other duties as assigned

Additional Job Description:

Education:
•    Bachelor of Science in Nursing (preferred) 
    
Experience: 
•    Two (2) years’ experience as an RN (required)
•    Additional (1) year experience in case management/utilization management (preferred)
Licensure:
•    Active Kentucky Registered Nurse License or compact license with privileges to work in Kentucky
Certification:
•    Case Management Certification (ACM, ANCC-Nurse Case Manager or CCM) preferred 
 

Share this job

Share to FB Share to LinkedIn Share to Twitter

Related Jobs

RN Full-time
Wellpath

Registered Nurse - RN- Days

You Matter • Make a difference every day in the lives of the underserved• Join a mission driven organization with a people first culture• Excellent career growth opportunities Join us and find a career that supports: • Caring for overlooked, underserved, and vulnerable patients• Diversity, equity, inclusion, and belonging• Autonomy in a warm team environment• Growth and training Perks and Benefits In addition to comprehensive benefits including medical, dental, vision, paid time off, and 401k, we foster a work, life balance for team members and their family to support physical, mental, and financial wellbeing including: • DailyPay, receive your money as you earn it! • Tuition Assistance and dependent Scholarships• Employee Assistance Program (EAP) including free counseling and health coaching• Company paid life insurance• Tax free Health Spending Accounts (HSA)• Wellness program featuring fitness memberships and product discounts• Preferred banking partnership and discounted rates for home and auto loans *Eligibility for perks and benefits varies based on employee type and length of service. Why Us Now is your moment to make a difference in the lives of the underserved. If there is one unifying characteristic of everyone on our team, it is the deep desire to make a difference by helping society's most vulnerable and often overlooked individuals. Every day we have the distinct honor and responsibility to show up with non-judgmental compassion to provide hope and healing to those who need it most. For those whose calling it is to serve others, now is your moment to join our mission to provide quality care to every patient with compassion, collaboration, and innovation, to live our mantra to “Always Do The Right Thing!”, and to collectively do our part to heal the world, one patient at a time. Wellpath sees hundreds of thousands of unique individuals in their facilities month over month and a very large percent of those individuals receive direct clinical care, which includes lives saved by Narcan. We offer ongoing training and development opportunities for licensed and unlicensed healthcare team members, and have best in class clinical resources for training, education, and point of care support. How you make a difference As a Registered Nurse (RN), your primary responsibility is to provide patient care using the nursing process of assessment, planning, implementation, and evaluation. You will work under the supervision of Charge Nurse(s) to provide patient education and activities in accordance with your competencies and education. This role requires excellent communication and critical thinking skills to ensure optimal patient outcomes. Key Responsibilities Assist in assessing and planning individual treatment programs, consulting with Charge Nurse(s) and other staff as necessary. Implement medical plans by administering medications, obtaining diagnostic tests, and assisting with medical or minor surgical procedures as needed. Count controlled substances and implement clinical and technical aspects of care in accordance with established policies, procedures, and protocols. Document nursing encounters using the SOAP form of charting as required by policy and attend mandatory staff meetings and training. Communicate information to nursing staff, physician, health care unit supervisory personnel or other staff as necessary. Qualifications & Requirements Education Graduate from an accredited school of nursing. Experience Prefer a minimum of one (1) year clinic experience Licenses/Certifications Have and maintain current licensure as a Registered Nurse within the state of employment. Must be able to obtain and maintain CPR certification. We are an Equal Employment Opportunity Employer We are committed to fostering, cultivating, and preserving a culture of uniqueness. We celebrate a variety of backgrounds and are committed to creating an inclusive environment for all employees. We encourage you to apply! If you are excited about a role but your experience doesn’t seem to align perfectly with every element of the job description, we encourage you to apply. You may be just the right candidate for this, or one of our many other roles. Deadline to apply to this position is contingent upon applicant volume. Those positions located in Colorado will have a specific deadline posted in the job description. We are an Affirmative Action Employer in accordance with applicable state and local laws.
RN Full-time
Wellpath

Registered Nurse- RN - Nights - $8500 Bonus

You Matter • Make a difference every day in the lives of the underserved• Join a mission driven organization with a people first culture• Excellent career growth opportunities Join us and find a career that supports: • Caring for overlooked, underserved, and vulnerable patients• Diversity, equity, inclusion, and belonging• Autonomy in a warm team environment• Growth and training Perks and Benefits In addition to comprehensive benefits including medical, dental, vision, paid time off, and 401k, we foster a work, life balance for team members and their family to support physical, mental, and financial wellbeing including: • DailyPay, receive your money as you earn it! • Tuition Assistance and dependent Scholarships• Employee Assistance Program (EAP) including free counseling and health coaching• Company paid life insurance• Tax free Health Spending Accounts (HSA)• Wellness program featuring fitness memberships and product discounts• Preferred banking partnership and discounted rates for home and auto loans *Eligibility for perks and benefits varies based on employee type and length of service. Why Us Now is your moment to make a difference in the lives of the underserved. If there is one unifying characteristic of everyone on our team, it is the deep desire to make a difference by helping society's most vulnerable and often overlooked individuals. Every day we have the distinct honor and responsibility to show up with non-judgmental compassion to provide hope and healing to those who need it most. For those whose calling it is to serve others, now is your moment to join our mission to provide quality care to every patient with compassion, collaboration, and innovation, to live our mantra to “Always Do The Right Thing!”, and to collectively do our part to heal the world, one patient at a time. Wellpath sees hundreds of thousands of unique individuals in their facilities month over month and a very large percent of those individuals receive direct clinical care, which includes lives saved by Narcan. We offer ongoing training and development opportunities for licensed and unlicensed healthcare team members, and have best in class clinical resources for training, education, and point of care support. How you make a difference As a Registered Nurse (RN), your primary responsibility is to provide patient care using the nursing process of assessment, planning, implementation, and evaluation. You will work under the supervision of Charge Nurse(s) to provide patient education and activities in accordance with your competencies and education. This role requires excellent communication and critical thinking skills to ensure optimal patient outcomes. Key Responsibilities Assist in assessing and planning individual treatment programs, consulting with Charge Nurse(s) and other staff as necessary. Implement medical plans by administering medications, obtaining diagnostic tests, and assisting with medical or minor surgical procedures as needed. Count controlled substances and implement clinical and technical aspects of care in accordance with established policies, procedures, and protocols. Document nursing encounters using the SOAP form of charting as required by policy and attend mandatory staff meetings and training. Communicate information to nursing staff, physician, health care unit supervisory personnel or other staff as necessary. Additional Details -This position is a FT/night shift position. -This position offers an $8500 bonus for full-time. Qualifications & Requirements Education Graduate from an accredited school of nursing. Experience Prefer a minimum of one (1) year clinic experience Licenses/Certifications Have and maintain current licensure as a Registered Nurse within the state of employment. Must be able to obtain and maintain CPR certification. We are an Equal Employment Opportunity Employer We are committed to fostering, cultivating, and preserving a culture of uniqueness. We celebrate a variety of backgrounds and are committed to creating an inclusive environment for all employees. We encourage you to apply! If you are excited about a role but your experience doesn’t seem to align perfectly with every element of the job description, we encourage you to apply. You may be just the right candidate for this, or one of our many other roles. Deadline to apply to this position is contingent upon applicant volume. Those positions located in Colorado will have a specific deadline posted in the job description. We are an Affirmative Action Employer in accordance with applicable state and local laws.
RN Full-time
Wellpath

Registered Nurse-Nights- $8,500.00 BONUS

You Matter • Make a difference every day in the lives of the underserved• Join a mission driven organization with a people first culture• Excellent career growth opportunities Join us and find a career that supports: • Caring for overlooked, underserved, and vulnerable patients• Diversity, equity, inclusion, and belonging• Autonomy in a warm team environment• Growth and training Perks and Benefits In addition to comprehensive benefits including medical, dental, vision, paid time off, and 401k, we foster a work, life balance for team members and their family to support physical, mental, and financial wellbeing including: • DailyPay, receive your money as you earn it! • Tuition Assistance and dependent Scholarships• Employee Assistance Program (EAP) including free counseling and health coaching• Company paid life insurance• Tax free Health Spending Accounts (HSA)• Wellness program featuring fitness memberships and product discounts• Preferred banking partnership and discounted rates for home and auto loans *Eligibility for perks and benefits varies based on employee type and length of service. Why Us Now is your moment to make a difference in the lives of the underserved. If there is one unifying characteristic of everyone on our team, it is the deep desire to make a difference by helping society's most vulnerable and often overlooked individuals. Every day we have the distinct honor and responsibility to show up with non-judgmental compassion to provide hope and healing to those who need it most. For those whose calling it is to serve others, now is your moment to join our mission to provide quality care to every patient with compassion, collaboration, and innovation, to live our mantra to “Always Do The Right Thing!”, and to collectively do our part to heal the world, one patient at a time. Wellpath sees hundreds of thousands of unique individuals in their facilities month over month and a very large percent of those individuals receive direct clinical care, which includes lives saved by Narcan. We offer ongoing training and development opportunities for licensed and unlicensed healthcare team members, and have best in class clinical resources for training, education, and point of care support. How you make a difference As a Registered Nurse (RN), your primary responsibility is to provide patient care using the nursing process of assessment, planning, implementation, and evaluation. You will work under the supervision of Charge Nurse(s) to provide patient education and activities in accordance with your competencies and education. This role requires excellent communication and critical thinking skills to ensure optimal patient outcomes. Key Responsibilities Assist in assessing and planning individual treatment programs, consulting with Charge Nurse(s) and other staff as necessary. Implement medical plans by administering medications, obtaining diagnostic tests, and assisting with medical or minor surgical procedures as needed. Count controlled substances and implement clinical and technical aspects of care in accordance with established policies, procedures, and protocols. Document nursing encounters using the SOAP form of charting as required by policy and attend mandatory staff meetings and training. Communicate information to nursing staff, physician, health care unit supervisory personnel or other staff as necessary. Qualifications & Requirements Education Graduate from an accredited school of nursing. Experience Prefer a minimum of one (1) year clinic experience Licenses/Certifications Have and maintain current licensure as a Registered Nurse within the state of employment. Must be able to obtain and maintain CPR certification. We are an Equal Employment Opportunity Employer We are committed to fostering, cultivating, and preserving a culture of uniqueness. We celebrate a variety of backgrounds and are committed to creating an inclusive environment for all employees. We encourage you to apply! If you are excited about a role but your experience doesn’t seem to align perfectly with every element of the job description, we encourage you to apply. You may be just the right candidate for this, or one of our many other roles. Deadline to apply to this position is contingent upon applicant volume. Those positions located in Colorado will have a specific deadline posted in the job description. We are an Affirmative Action Employer in accordance with applicable state and local laws.
RN Full-time
Wellpath

Registered Nurse (RN) - Nights

You Matter • Make a difference every day in the lives of the underserved• Join a mission driven organization with a people first culture• Excellent career growth opportunities Join us and find a career that supports: • Caring for overlooked, underserved, and vulnerable patients• Diversity, equity, inclusion, and belonging• Autonomy in a warm team environment• Growth and training Perks and Benefits In addition to comprehensive benefits including medical, dental, vision, paid time off, and 401k, we foster a work, life balance for team members and their family to support physical, mental, and financial wellbeing including: • DailyPay, receive your money as you earn it! • Tuition Assistance and dependent Scholarships• Employee Assistance Program (EAP) including free counseling and health coaching• Company paid life insurance• Tax free Health Spending Accounts (HSA)• Wellness program featuring fitness memberships and product discounts• Preferred banking partnership and discounted rates for home and auto loans *Eligibility for perks and benefits varies based on employee type and length of service. Why Us Now is your moment to make a difference in the lives of the underserved. If there is one unifying characteristic of everyone on our team, it is the deep desire to make a difference by helping society's most vulnerable and often overlooked individuals. Every day we have the distinct honor and responsibility to show up with non-judgmental compassion to provide hope and healing to those who need it most. For those whose calling it is to serve others, now is your moment to join our mission to provide quality care to every patient with compassion, collaboration, and innovation, to live our mantra to “Always Do The Right Thing!”, and to collectively do our part to heal the world, one patient at a time. Wellpath sees hundreds of thousands of unique individuals in their facilities month over month and a very large percent of those individuals receive direct clinical care, which includes lives saved by Narcan. We offer ongoing training and development opportunities for licensed and unlicensed healthcare team members, and have best in class clinical resources for training, education, and point of care support. How you make a difference As a Registered Nurse (RN), your primary responsibility is to provide patient care using the nursing process of assessment, planning, implementation, and evaluation. You will work under the supervision of Charge Nurse(s) to provide patient education and activities in accordance with your competencies and education. This role requires excellent communication and critical thinking skills to ensure optimal patient outcomes. Key Responsibilities Assist in assessing and planning individual treatment programs, consulting with Charge Nurse(s) and other staff as necessary. Implement medical plans by administering medications, obtaining diagnostic tests, and assisting with medical or minor surgical procedures as needed. Count controlled substances and implement clinical and technical aspects of care in accordance with established policies, procedures, and protocols. Document nursing encounters using the SOAP form of charting as required by policy and attend mandatory staff meetings and training. Communicate information to nursing staff, physician, health care unit supervisory personnel or other staff as necessary. Qualifications & Requirements Education Graduate from an accredited school of nursing. Experience Prefer a minimum of one (1) year clinic experience Licenses/Certifications Have and maintain current licensure as a Registered Nurse within the state of employment. Must be able to obtain and maintain CPR certification. We are an Equal Employment Opportunity Employer We are committed to fostering, cultivating, and preserving a culture of uniqueness. We celebrate a variety of backgrounds and are committed to creating an inclusive environment for all employees. We encourage you to apply! If you are excited about a role but your experience doesn’t seem to align perfectly with every element of the job description, we encourage you to apply. You may be just the right candidate for this, or one of our many other roles. Deadline to apply to this position is contingent upon applicant volume. Those positions located in Colorado will have a specific deadline posted in the job description. We are an Affirmative Action Employer in accordance with applicable state and local laws.
RN Full-time
Wellpath

Registered Nurse-12/Nights/$8500.00 BONUS applicable

You Matter • Make a difference every day in the lives of the underserved• Join a mission driven organization with a people first culture• Excellent career growth opportunities Join us and find a career that supports: • Caring for overlooked, underserved, and vulnerable patients• Diversity, equity, inclusion, and belonging• Autonomy in a warm team environment• Growth and training Perks and Benefits In addition to comprehensive benefits including medical, dental, vision, paid time off, and 401k, we foster a work, life balance for team members and their family to support physical, mental, and financial wellbeing including: • DailyPay, receive your money as you earn it! • Tuition Assistance and dependent Scholarships• Employee Assistance Program (EAP) including free counseling and health coaching• Company paid life insurance• Tax free Health Spending Accounts (HSA)• Wellness program featuring fitness memberships and product discounts• Preferred banking partnership and discounted rates for home and auto loans *Eligibility for perks and benefits varies based on employee type and length of service. Why Us Now is your moment to make a difference in the lives of the underserved. If there is one unifying characteristic of everyone on our team, it is the deep desire to make a difference by helping society's most vulnerable and often overlooked individuals. Every day we have the distinct honor and responsibility to show up with non-judgmental compassion to provide hope and healing to those who need it most. For those whose calling it is to serve others, now is your moment to join our mission to provide quality care to every patient with compassion, collaboration, and innovation, to live our mantra to “Always Do The Right Thing!”, and to collectively do our part to heal the world, one patient at a time. Wellpath sees hundreds of thousands of unique individuals in their facilities month over month and a very large percent of those individuals receive direct clinical care, which includes lives saved by Narcan. We offer ongoing training and development opportunities for licensed and unlicensed healthcare team members, and have best in class clinical resources for training, education, and point of care support. How you make a difference As a Registered Nurse (RN), your primary responsibility is to provide patient care using the nursing process of assessment, planning, implementation, and evaluation. You will work under the supervision of Charge Nurse(s) to provide patient education and activities in accordance with your competencies and education. This role requires excellent communication and critical thinking skills to ensure optimal patient outcomes. Key Responsibilities Assist in assessing and planning individual treatment programs, consulting with Charge Nurse(s) and other staff as necessary. Implement medical plans by administering medications, obtaining diagnostic tests, and assisting with medical or minor surgical procedures as needed. Count controlled substances and implement clinical and technical aspects of care in accordance with established policies, procedures, and protocols. Document nursing encounters using the SOAP form of charting as required by policy and attend mandatory staff meetings and training. Communicate information to nursing staff, physician, health care unit supervisory personnel or other staff as necessary. Qualifications & Requirements Education Graduate from an accredited school of nursing. Experience Prefer a minimum of one (1) year clinic experience Licenses/Certifications Have and maintain current licensure as a Registered Nurse within the state of employment. Must be able to obtain and maintain CPR certification. We are an Equal Employment Opportunity Employer We are committed to fostering, cultivating, and preserving a culture of uniqueness. We celebrate a variety of backgrounds and are committed to creating an inclusive environment for all employees. We encourage you to apply! If you are excited about a role but your experience doesn’t seem to align perfectly with every element of the job description, we encourage you to apply. You may be just the right candidate for this, or one of our many other roles. Deadline to apply to this position is contingent upon applicant volume. Those positions located in Colorado will have a specific deadline posted in the job description. We are an Affirmative Action Employer in accordance with applicable state and local laws.