Nursing Jobs in Superior, CO
$84,558.69 - $126,838.03 / year
Job Overview The Utilization Review RN participates as a member of a multidisciplinary team to support medical necessity reviews, ensure compliance, and actively participate in denial mitigation. It is a collaborative approach that uses pre-established guidelines and criteria to perform review activities to ensure the proper utilization of hospital services and payment of those services by Medicare, Medicaid, and other third-party payors. Department Name: Case Management - Utilization Review Job Status: full time, 40 hours per week, eligible for benefits Shift: Dayshift Monday through Friday 0800-1630 This position will be primarily remote but there may be occasions when you are expected to work onsite at one of the Children’s Hospital Colorado locations. The specific details will be discussed in the interview process, and subject to change at our discretion. Applicants must already reside in Colorado or be willing to relocate prior to starting. This position is eligible for relocation assistance, if relocating from 100 miles or greater. Duties & Responsibilities An employee in this position may be called upon to do any or all the following essential functions. These examples do not include all the functions which the employee may be expected to perform. Assesses all new inpatient admissions for identification of status and medical necessity for admission; communicates clinical review process with appropriate Payors. Assesses the continuity of care in conjunction with the Case Managers regarding the continued medical necessity of hospitalization and the status of the discharge plan; communicates this to the appropriate payors. Coordinates with other members of the healthcare team to help identify and control inappropriate resource utilization. Conducts concurrent admission and continued stay reviews based on appropriate utilization review criteria. Utilizes information provided by Patient Access regarding authorized length of stay and follows up with third-party payors on an ongoing basis, documents communications regarding continued authorizations. Follows up on denials communicated to the department and works with the revenue cycle staff to assist with appeals. Maintains and demonstrates appropriate clinical knowledge to assist physicians in providing documentation of severity of illness and intensity of service to assure that criteria for acute hospitalization are met. Employees are expected to comply with all regulatory requirements, including CMS and Joint Commission Standards. Minimum Qualifications Education: Bachelor of Science in Nursing (BSN) Experience: Three years of recent clinical or case management experience that includes recent UR experience in a hospital or with a Third-Party Payor Certification(s): BLS/CPR from the American Heart Association with at least 6 months left before expiration is required upon hire. Licensure(s): Registered Nurse License Salary Information Pay is dependent on applicant's relevant experience. Annual Salary Range (Based on 40 hours worked per week): $84,558.69 to $126,838.03 Benefits Information Here, you matter. As a Children’s Hospital Colorado team member, you will receive a competitive pay and benefits package designed to take care of your needs that includes base pay, incentives, paid time off, medical/dental/vision insurance, company provided life and disability insurance, paid parental leave, 403b employer match (retirement savings), a robust wellness program, and access to professional development tools, including an education benefit to help you advance your career. As part of our Total Rewards package, Children's Colorado offers an annual employee bonus program that rewards eligible team members based on organizational performance. If organizational goals are met for the year, the bonus is paid out the following April. Children’s Colorado delivers annual base pay increases to eligible team members based on their performance over the previous year. EEO Statement It is our intention that all qualified applicants be given equal opportunity and that selection decisions be based on job-related factors. We do not discriminate on the basis of race, color, religion, national origin, sex, age, disability, or any other status protected by law or regulation. Be aware that none of the questions are intended to imply illegal preferences or discrimination based on non-job-related information. The position is expected to stay open until the posted close date. Please submit your application as soon as possible as the posting is subject to close at any time once a sufficient pool of qualified applicants is obtained. Colorado Residents: In any materials you submit, you may redact or remove age-identifying information such as age, date of birth, or dates of attendance at or graduation from an educational institution. You will not be penalized for redacting or removing this information. 
$110,577 - $144,966 / year
Description At UCHealth, our mission is simple - to improve lives. That starts with you. We improve lives through fresh ideas, innovative approaches and an unwavering commitment to world-class care. UCHealth Medical Group is ready to welcome a full-time, Nurse Practitioner or Physician Assistant to join our Virtual Primary Care Clinic. At UCHealth, we believe each person is extraordinary, and together, we make extraordinary possible. Remote, work-from-home position, with option to work from the UCHealth Virtual Health Center in Aurora Enjoy 36 patient facing hours a week Integrated behavioral health is available to support your practice Provide primary care via video visits for new and established patients across UCHealth Medical Group, including empaneled ‘Virtual Care’ patients Provide supervision for advanced practice providers within virtual primary care including providing clinical/quality guidance, oversight, mentorship and responsibility for annual career conversations. · In partnership with the virtual health center operations manager, provide clinical leadership and oversight. Specialists at your fingertips throughout the UCHealth system REQUIRED: 2-3 years’ primary care experience required. Reside in Colorado with an unrestricted Colorado license to practice as a Advanced Practice Provider in the state of Colorado. EPIC EMR is utilized system-wide. We know how fast the world of healthcare is changing, and we push ourselves to stay ahead of the curve. The UCHealth Medical Group is physician led and employs nearly 2,000 physicians and advanced practice providers who aim to anticipate and address patients’ every health need. We call on providers in every career stage and specialty to lead and provide direction for the future of healthcare at UCHealth. Apply today. This position will be open for a minimum of 3 days and will remain open until a top candidate is identified. We are unable to support visa candidates for this position. Requirements for Physician Assistants Master’s Degree in Physician Assistant Studies Unrestricted license to practice as a Physician Assistant in the State of Colorado. Physician Assistant Certification (PA-C) issued by the National Commission for Certification of Physician Assistants (NCCPA) is required for hire and must be maintained throughout employment Unrestricted Drug Enforcement Administration (DEA) permit to prescribe all medications commonly prescribed in the course of practice. Eligible to provide services, reimbursable services, and maintain provider status with Medicare and Medicaid. Eligible to provide services with no sanctions or exclusion from either the Health and Human Services/Office of Inspectors General (HHS/OIG) or the General Services Administration’s (GSA) List of Parties Excluded from Federal Programs. Unrestricted medical staff membership, with appropriate practice privileges. Prescriptive authority as appropriate, per medical staff service privileging process. Basic Life Support (BLS) certification issued by the American Heart Association or the American Red Cross. Requirements for Nurse Practitioners Full or provisional prescriptive authority eligibility is required. Provider must apply for prescriptive authority as a condition of employment. Master’s degree in nursing and graduate of an accredited Nurse Practitioner program Nurse Practitioner Certification issued by the American Nurses Credentialing Center (ANCC) or Nurse Practitioner Certification issued by the American Academy of Nurse Practitioners Certification Board (AANPCB) is required for hire and must be maintained throughout employment. Unrestricted Nurse Practitioner license issued by the State Board of Nursing in the state of practice or compact privileges under the multi-state Nurse Licensure Compact agreement Unrestricted medical staff membership, with appropriate practice privileges Unrestricted Drug Enforcement Administration (DEA) permit to prescribe all medications commonly prescribed in the course of practice. Eligible to provide services, reimbursable services, and maintain provider status with Medicare and Medicaid. Eligible to provide services with no sanctions or exclusion from either the Health and Human Services/Office of Inspectors General (HHS/OIG) or the General Services Administration’s (GSA) List of Parties Excluded from Federal Programs. Basic Life Support (BLS) certification issued by the American Heart Association or the American Red Cross Exceptional Benefits This position offers a competitive compensation package: The pay range for this full-time position is $110,577 - $144,966 annually. Pay is dependent on applicant's relevant experience. Annual Quality Value Incentive Plan (QVIP) of up to $10,000. Relocation bonus of up to $10,000, if eligible. Paid malpractice. Continuing medical education (CME) of up to $3,500 and up to 5 days annually. 403(b) with employer matching contribution; 457(b) voluntary option if eligible. Exceptional health and welfare benefits including medical, vision, dental, life insurance, and disability coverage including coverage for eligible dependents. UCHealth is a qualifying employer for the federal Public Service Loan Forgiveness (PSLF) program. UCHealth provides employees with free assistance navigating the PSLF program. UCHealth provides employer-paid short-term disability (STD) coverage as a supplement to Colorado FAMLI, offering up to 66.67% of your base pay. We also offer employer-provided long-term disability (LTD) coverage, which equals 50% of your base pay, up to $17,500 per month. Additionally, you have the option to buy up LTD coverage to 60% or 66.7%. Wellness benefits. Full suite of voluntary benefits such as flexible spending accounts for health care and dependent care, health savings accounts (available with HD/HSA medical plan only), identity theft protection, pet insurance, and employee discount programs. Time away from work: paid time off (PTO), paid family and medical leave (inclusive of Colorado FAMLI), leaves of absence; start your employment at UCHealth with PTO in your bank. Education benefits for employees, including the opportunity to be eligible for 100% tuition, books, and fees paid for by UCHealth for specific educational degrees. Other programs may qualify for up to $5,250 pre-paid by UCHealth or in the form of tuition reimbursement each calendar year. About UCHealth UCHealth is an innovative, nonprofit health system that delivers the highest quality medical care with an excellent patient experience . UCHealth includes 33,000 employees, 14 acute-care hospitals, and hundreds of physicians across Colorado, southern Wyoming, and western Nebraska. With University of Colorado Hospital on the CU Anschutz Medical Campus as its academic anchor and the only adult academic medical center in the region, UCHealth is dedicated to providing unmatched patient care in the Rocky Mountain West. Offering more than 150 clinic locations, UCHealth provides extensive community benefits and pushes the boundaries of medicine through advanced treatments and clinical trials, improving health through innovation. Going beyond quality requires the perfect balance of talent, integrity, drive, and intellectual curiosity. We are looking for individuals who recognize, like us, that the world of medicine is ever-changing and are motivated to do what is right, not what is easy. We support creativity and curiosity so that each of us can find extraordinary qualities within ourselves. At UCHealth, we'll do everything in our power to make sure you grow and have a meaningful career. There are no limits to your potential here. The UCHealth Medical Group Office of Advanced Practice (OAP) actively supports the integration of APPs throughout the medical group to promote optimal and excellent patient care. We are committed to supporting APP practice and professional development while cultivating community and connection among all members of the healthcare team. We do this through bi-directional communication, mentorship, and leadership development, which can lead to opportunities for APP involvement in committees and leadership positions. UCHealth recognizes and appreciates the rich array of talents and perspectives that equal employment and diversity can offer our institution. As an affirmative action/equal opportunity employer, UCHealth is committed to making all employment decisions based on valid requirements. No applicant shall be discriminated against in any terms, conditions or privileges of employment or otherwise be discriminated against because of the individual’s race, creed, color, religion, gender, national origin or ancestry, age, mental or physical disability, sexual orientation, gender identity, transgender status, genetic information or veteran status. UCHealth does not discriminate against any “qualified applicant with a disability” as defined under the Americans with Disabilities Act and will make reasonable accommodations, when they do not impose an undue hardship on the organization.