Top 8 Utilization review Jobs in Meeker, Co

Utilization Review Registered Nurse : On Site Position
Pioneers Medical Center —Meeker, CO
- $33.50 - $53.00 an hour
- Part-time
- RN License
- Hospital
- Mid-level
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Walker Healthforce, LLC —United States
- Contract
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- 3 years
- Health insurance
- Dental insurance
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APN Staffing & Employment Solutions —United States
- $100,000 a year
- Full-time
- Remote
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- Mid-level
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Registered Nurse | Review Analyst I | Remote | Detroit, MI | Contract
Walker Healthforce, LLC —United States
Current, unrestricted Michigan Registered Nurse (RN) license. Bachelor's degree in Nursing (BSN) or related field. Conduct quality reviews on clinical cases.
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Utilization Review Registered Nurse : On Site Position

Pioneers Medical Center -
Meeker, CO

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Job Details

Part-time
$33.50 - $53.00 an hour

Qualifications

Healthcare staff management
RN License
Acute care facility experience
Schedule management
Team management

Full Job Description

Reports To : Director of Nursing; Acute and Emergency Department

FLSA Classification: Part-Time, Non-Exempt, Hourly $33.50 - $49-53

Essential Functions:

The Part-Time Utilization Review Nurse is a Registered Nurse (RN) responsible for conducting utilization reviews to determine the medical necessity and appropriateness of patient admissions, continued hospital stays, and the level of care provided. This role ensures compliance with regulatory requirements and payer guidelines, proactively identifies potential barriers to discharge, and works to prevent claim denials, thereby supporting efficient patient throughput and optimal resource utilization within the hospital.

Perform concurrent and retrospective utilization reviews for all patient admissions and continued stays, applying established medical necessity criteria (e.g. InterQual, Milliman Care Guidelines), and payer specific guidelines.

Communicate effectively with attending physicians, residents, and other healthcare providers regarding medical necessity, documentation requirements, and alternative levels of care.

Identify and address potential barriers to discharge, collaborating with the Case Management team to facilitate timely patient progression.

Document all review activities, including approvals, denials, and appeals processes, accurately and thoroughly in the electronic health record (EHR) system.

Assist in the preparation and submission of appeals for denied services, providing clinical rationale and supporting documentation.

Stay current with Medicare, Medicaid, and commercial payer regulations, policies, and medical necessity criteria.

Collaborate with the Case Management team to ensure seamless coordination between utilization review and discharge planning activities.

Participate in interdisciplinary team meetings to discuss patient status, care progression, and discharge readiness.

Provide education to physicians and other staff on documentation requirements for medical necessity.

Monitor readmissions and avoidable days in Meditech for quality improvement initiatives.

Coordinate in advance discharge planning for orthopedic surgical patients, ensuring timely referrals, equipment orders, and post-discharge services.

Actively participate in the Utilization Review (UR) Committee.

Perform other duties as assigned to support utilization management, case management, and hospital operations.

Other duties as assigned.

Education and Experience:

Previous experience in managing staff and schedules required.

Active, unencumbered Registered Nurse (RN) license in Colorado or Compact-state license that includes Colorado.

Two (2) to three (3) years’ of recent clinical experience in an acute care setting required.

One (1) year of experience in Utilization Review or Case Management preferred.

Strong knowledge of Medicare, Medicaid, and commercial payer regulations, as well as medical necessity criteria (e.g., InterQual, Milliman Care Guidelines).

Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights (https://www.eeoc.gov/poster) notice from the Department of Labor.

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utilization review jobs in meeker, co

Utilization Review Registered Nurse : On Site Position

Registered Nurse | Review Analyst I | Remote | Detroit, MI | Contract

Remote Psychologist - US Location

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