RN-Utilization Review, Care Management, First Shift
UofL Health
- Louisville, KY
- Permanent
- Full-time
Location: 1850 Bluegrass Ave. Louisville, KY 40215
Shift Options: First Shift, Full-TimeAbout Us
UofL Health - Mary & Elizabeth Hospital is a 298-bed, full-service hospital which has served generations of patients in south Louisville. Originally founded by the Sisters of Charity of Nazareth in 1874, the hospital offers a full range of vascular, orthopedic, cardiac, neurological, surgical, rehabilitative and 24/7 emergency services including 24/7 STEMI service.
Mary & Elizabeth Hospital is home to UofL Health – Weight Loss Care, the region’s only weight-loss management program utilizing the Lap-Band® System. In addition, the hospital provides the Orbera® gastric balloon procedure. The hospital has been recognized as one of the first health care facilities in the nation to receive a Blue Distinction® Center for bariatric surgery.
The hospital partnered with sister facility, UofL Health – Peace Hospital to open a voluntary inpatient medical detox unit at Mary & Elizabeth Hospital to care for patients with substance use disorders. Most recently, Cancer & Blood Specialists, located adjacent to the Mary & Elizabeth Hospital campus, became the third location of UofL Health – Brown Cancer Center. At the center, patients will have continuity of care with trusted oncology and hematology providers, along with access to the multidisciplinary care, pioneering research and clinical trials of the Brown Cancer Center. In addition to the hospital, Mary & Elizabeth has three medical plazas on its campus to provide office space for a wide array of primary care and specialty physicians.Our Mission
As an academic health care system, we will transform the health of the communities we serve through compassionate, innovative, patient-centered care.ResponsibilitiesJob SummaryUnder 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.QualificationsBenefits & 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
Partner401K with Employer Match
Opportunities for Advancement#LI-DNIEDUCATION & TRAINING:BSN or RN with a Bachelors Degree in Business or Health Care Administration preferred. Will consider RN with A.D.N. if actively pursuing BSN, with BSN completion required within 2 years of hire.EXPERIENCE: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.LICENSE & CERTIFICATION:Active and unrestricted RN license in Kentucky required. ANCC Certification in a Nursing Case Management, ACM or CCM preferred.