Utilization Review Rn Jobs in Denver, CO (NOW HIRING)

The estimate displayed represents the typical wage range of candidates hired. Factors that may be used to determine your actual salary may include your specific skills, how many years of experience you have and comparison to other employees already in this role. The typical candidate is hired below midpoint of the range.

Experience the HCA Healthcare difference where colleagues are trusted, valued members of our healthcare team. Grow your career with an organization committed to delivering respectful, compassionate care, and where the unique and intrinsic worth of each individual is recognized. Submit your application for the opportunity below: RN Case Manager PRN 

The RN CM is responsible for promoting patient-centered care by coordinating the plan of care for the patient stay, managing the length of stay, ensuring appropriate resource management and developing a safe appropriate discharge plan in collaboration with the multidisciplinary team. The RN CM facilitates the progression and transition of care using established criteria and in conjunction with the multidisciplinary team. The RN CM will coordinate activities that promote quality outcomes and patient throughput while supporting a balance of optimal care and appropriate resource utilization 

Performance Expectations 

• Provides case management services for both inpatient and observation patients as assigned 

• Identifies patients who are at risk for adverse outcomes during the transition from one level of care/setting to another 

• Performs a comprehensive assessment of psychosocial, medical and discharge needs of patients/family along with an assessment of resources appropriate and available to the patient/family 

• Reassesses the patient’s clinical condition as indicated. Considers patient’s readmission status or risk of readmission and develops strategies to mitigate including education on appropriately accessing healthcare resources, preventative education, and community based resources 

• Coordinates the plan of care and drives the discharge plan by collaborating with the multidisciplinary health care team and in particular with the patient's physician to facilitate a successful care transition 

• In partnership with Social Services, the RN CM is responsible for ensuring the post-acute medical needs and level of care are appropriate 

• The RN CM is responsible for timely referral to Social Services when risk factors for psychosocial determinants of health are identified 

• Involves patient, family/responsible/significant others in identifying and clarifying needs and expectations to develop mutual and realistic goals 

• Evaluates progression of care using evidence-based tools and approved criteria (InterQual) throughout the episode of care; escalates progression and transition of care issues through the established chain of command 

• Makes appropriate referrals to third party payer, disease and case management programs for recurring patients and patients with chronic disease states 

• Facilitates patient throughput with an ongoing focus on an effective care transition, quality and efficiency 

• Documents professional recommendations, discharge plan, care coordination interventions, and case management activities to effectively communicate to all members of the health care team 

• Align patient’s needs with available resources to ensure a safe discharge / transition 

• Acts as a liaison through effective and professional communications between and with physicians, patient / family, hospital staff, and outside agencies 

• Actively seeks ways to control costs without compromising patient safety, quality of care or the services delivered 

• Directs activities to identify and provide for the needs of the under-resourced patient population to include patient education activities, patient assistance programs, and community-based resources 

• Participates in performance improvement activities including, but not limited to, identifying, documenting and intervening when avoidable days occur 

• Adheres to established policy and procedure and standards of care; escalates issues through the established chain of command timely 

• Demonstrates knowledge of regulatory requirements, HCA Ethics and Compliance policies, and quality initiatives 

• Serve as an advocate for patient's rights, needs, and values; ensuring that patients’ ethnic, cultural, or religious values, beliefs, preferences and needs are considered and aligned 

• Other duties as assigned 

II.Position Requirements: 

1.  Licensure/Certification/Registration:  Current licensure in the State of Colorado as a Registered Nurse, or current active multistate Registered Nurse license 

1. Education:  Graduate of an accredited School of Nursing. Bachelor of Science Nursing preferred. Certification in case management or utilization review preferred 

1. Experience:  Three years’ clinical, hospital nursing experience required with preference given to those with 2 years of case management experience or 2 years of critical care experience. InterQual experience preferred 

1. Knowledge, Skills and Abilities:  Ability to establish and maintain collaborative and effective working relationships. Ability to communicate effectively in oral, written and electronic formats. Demonstrates analytical and critical thinking abilities with proactive decision-making and negotiation skills 

HCA HealthONE Rose, offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and programs include:

• Comprehensive benefits for medical, prescription drug, dental, vision, behavioral health and telemedicine services
• Wellbeing support, including free counseling and referral services
• Time away from work programs for paid time off, paid family leave, long- and short-term disability coverage and leaves of absence
• Savings and retirement resources, including a 401(k) Plan with a 100% match on 3% to 9% of pay (based on years of service), Employee Stock Purchase Plan, flexible spending accounts, preferred banking partnerships, retirement readiness tools, rollover support and financial wellbeing counseling
• Education support through tuition assistance, student loan assistance, certification support, dependent scholarships and a partnership with Galen College of Nursing
• Additional benefits for fertility and family building, adoption assistance, life insurance, supplemental health protection plans, auto and home insurance, legal counseling, identity theft protection and consumer discounts

Learn more about Employee Benefits

Note: Eligibility for benefits may vary by location.

HCA HealthONE, one of the largest and most comprehensive healthcare systems in the Rocky Mountain region, offers more than 170 care sites in the Denver metro area. Offering services across the continuum of care to meet patients’ total healthcare needs, HCA HealthONE includes seven acute care hospitals, a dedicated flagship pediatric hospital, a rehabilitation hospital, CareNow® urgent care clinics, mental health campuses, imaging and surgery centers, physician practices, home and hospice care, and AirLife Denver, which provides regional critical care air and ground transportation. Among HCA HealthONE’s acute care hospitals is Rose. HCA HealthONE Rose has earned its reputation through Rose Babies as Denver's “baby hospital” while becoming a leader in comprehensive women's care. Expert care in orthopedics and total joint replacement, heart and vascular care, oncology, and weight-loss treatment are also pillars of the quality services provided at HCA HealthONE Rose, a proud Magnet-designated hospital for nursing excellence by the American Nurses Credentialing Center. Consistently among the Denver Business Journals’ list of top corporate philanthropists in the Denver-metro area, HCA HealthONE was named as one of the most community-minded organizations by The Civic 50 and contributed more than $1 million through cash and in-kind donations last year alone, along with more than $400M in federal, state and local taxes.

HCA Healthcare has been recognized as one of the World’s Most Ethical Companies® by the Ethisphere Institute more than ten times. In recent years, HCA Healthcare spent an estimated $3.7 billion in costs for the delivery of charitable care, uninsured discounts, and other uncompensated expenses.

If you find this opportunity compelling, we encourage you to apply for our RN Case Manager PRN opening. We promptly review all applications. Highly qualified candidates will be directly contacted by a member of our team. We are interviewing - apply today!

We are an equal opportunity employer. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.