Utilization Review RN

Where You’ll Work

CommonSpirit Health was formed by the alignment of Catholic Health Initiatives (CHI) and Dignity Health. With more than 700 care sites across the U.S., from clinics and hospitals to home-based care and virtual care services, CommonSpirit is accessible to nearly one out of every four U.S. residents. Our world needs compassion like never before. Our communities need caring and our families need protection. With our combined resources, CommonSpirit is committed to building healthy communities, advocating for those who are poor and vulnerable, and innovating how and where healing can happen, both inside our hospitals and out in the community.

Job Summary and Responsibilities

Conducts admission and continued stay reviews per the Care Coordination Utilization Review guidelines to ensure that the hospitalization is warranted based on established criteria and critical thinking.  Reviews include admission, concurrent and post discharge for appropriate status determination.

Ensures compliance with principles of utilization review, hospital policies and external regulatory agencies, Peer Review Organization (PRO), Joint Commission, and payer defined criteria for eligibility.

Reviews the records for the presence of accurate patient status orders and addresses deficiencies with providers.

Ensures timely communication and follow up with physicians, payers, Care Coordinators and other stakeholdersregarding review outcomes.

Collaborates with facility RN Care Coordinators to ensure progression of care.

Engages the second level physician reviewer, internal or external, as indicated to support the appropriate status.

Communicates the need for proper notifications and education in alignment with status changes.

Job Requirements

Graduate of an accredited school of nursing

RN license