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RN Utilization Reviewer

Jefferson County, Colorado

Jefferson County, Colorado

Golden, CO, USA
Posted on Friday, June 7, 2024
Apply By:

06/10/24

Division:

Community Assistance Division

Management Level:

Individual Contributor

Scheduled Weekly Hours:

40

Benefit Eligibility:

This position is eligible for Standard Benefits which includes dental, medical, and vision insurance, paid time off and holidays, retirement matching, wellness programs, and tuition reimbursement.

Description:

The RN Utilization Reviewer is responsible for providing utilization reviews of Medicaid long term home health requests. Provide consulting and education for Options for Long Term Care staff and community home health agencies regarding Medicaid long term home health. Conduct client assessments, provide case management and complete documentation for Options for Long Term Care (OLTC). Reports to the Long-Term Care Case Management Supervisor.

The ideal candidate thrives in an independent and autonomous work environment supporting new applicants for Long Term care by exhibiting a positive outlook and excellent customer service by effectively responding to client needs and coordinating with other community agencies and health providers. This individual works with a dedicated team to ensure the best care options are provided to those seeking it. If you are looking for the opportunity to make a difference in the lives of the community that you serve, we encourage you to apply!

Schedule :

At the county we offer a variety of flexible schedules this position can either work a 4-day 10-hour work week or 5-day 8-hour work week. This position requires regular on-site/in-office/ in the community work in support of our clients. This position does have the ability to work in a hybrid capacity , if the programs needs are met. In state of Colorado applicants only.

**No nights, evenings or weekends!**

Compensation :

Hiring Range: $49,000 - $60,000 USD Annually

We are seeking to hire at or below midpoint $59,862. Compensation will be determined based on education, experience, and skills.

Benefits : Jefferson County offers a generous benefits package that supports your personal and professional life. Benefits include medical, dental and vision insurance, paid time off and holidays, retirement matching, wellness programs, tuition reimbursement, flexible schedules, remote work options and more . For more information, c lick Here for our Total Rewards summary.

The RN Utilization Reviewer is responsible for providing utilization reviews of Medicaid long term home health requests. Provide consulting and education for Options for Long Term Care staff and community home health agencies regarding Medicaid long term home health. Conduct client assessments, provide case management and complete documentation for Options for Long Term Care (OLTC). Reports to the Long-Term Care Case Management Supervisor.

The ideal candidate thrives in an independent and autonomous work environment supporting new applicants for Long Term care by exhibiting a positive outlook and excellent customer service by effectively responding to client needs and coordinating with other community agencies and health providers. This individual works with a dedicated team to ensure the best care options are provided to those seeking it. If you are looking for the opportunity to make a difference in the lives of the community that you serve, we encourage you to apply!

Schedule :

At the county we offer a variety of flexible schedules this position can either work a 4-day 10-hour work week or 5-day 8-hour work week. This position requires regular on-site/in-office/ in the community work in support of our clients. This position does have the ability to work in a hybrid capacity , if the programs needs are met. In state of Colorado applicants only.

  • No nights, evenings or weekends!* *

Compensation :

Hiring Range: $49,000 - $60,000 USD Annually

Compensation will be determined based on education, experience, and skills.

Benefits : Jefferson County offers a generous benefits package that supports your personal and professional life. Benefits include medical, dental and vision insurance, paid time off and holidays, retirement matching, wellness programs, tuition reimbursement, flexible schedules, remote work options and more . For more information, c lick Here for our Total Rewards summary.

Essential Duties:

  • Process request, adhering to all appropriate Volume 8 Rules; DALs and Medicaid bulletins. Cooperate with assigned OLTC or case management agency. Aid and consultation as needed. Some cases are processed by RN alone. Approve, partially approve, hold or deny request for skilled services provided in the client's home.
  • Maintain client records, using databases and data entry on various computer systems in OLTC, Jefferson County and the Colorado Department of Health Care Policy and Financing. Ensure appropriateness and timeliness.
  • Act as consultant, educator or trainer to OLTC and case management agency. Act as liaison to community home health agencies regarding Long Term Home Health (LTHH) skilled services, regulations and paperwork. Determine assistance or training needs and how best to provide the information.
  • Receive long term home health prior authorization requests. Screen to determine if paperwork is correct and complete. Return to sender for corrections, request additional information, handle personally or assign to case manager.
  • Participate in additional utilization review of OLTC programs and audits at supervisor's request. Ensure all LTHH timelines continue to be met while assisting with special projects.
  • Complete ULTC 100.2 assessments when needed, via phone or in client's home. Approve or deny client for program eligibility.
  • RN signature required for denied or partially denied services. Must be able to represent the OLTC agency and defend the decision at State appeal hearings. Determine denial regulation.
  • Other duties and responsibilities as assigned.

Qualifications:

Research shows that women and other underrepresented and historically marginalized groups tend to apply only when they check every box in the posting. If you are reading this and hesitating to click “apply” for that reason, we encourage you to go for it! A true passion and excitement for making an impact is just as important as work experience.

Minimal Qualifications:

  • Bachelor's degree in nursing and minimum one-year of public health work related experience or equivalent.
  • Licensed as a Registered Nurse (RN) in Colorado, or in a state that has enacted the RN Nurse Licensure Compact at time of employment and renewed annually.

Preferred Knowledge, Skills And Abilities:

  • Strongly prefer practicing RN experience or at least 2-3 years in clinical nursing, including utilization management experience in a managed care or hospital environment, and immunization experience
  • Strong customer service skills
  • Strong written and oral communication
  • Must thrive at working independently
  • Independent critical thinking and analysis
  • Demonstrating initiative, innovation, and resiliency
  • Strong time management and prioritization skills

Additional Job Information:

  • Offer of employment contingent upon successful completion of criminal history, motor vehicle report, education verification, and/or references.
  • Please note that supplemental questions requiring a written response will serve as a writing sample.
  • Note: Must be a Colorado resident at time of hire.

How To Apply:

Applications will be accepted electronically at Jefferson County Colorado Career Opportunities .

Applicants complete an online form and have the option to provide a resume and detailed cover letter that describes why you are the best candidate for the position. Applications are reviewed for minimum qualifications listed in the qualifications section of the job bulletin, and applicants are contacted directly by the hiring team regarding next steps. To view the status of your application or direct communication from the hiring team, please log into your candidate portal .

For more details on the recruitment process, please visit https://www.jeffco.us/1860/FAQs

Questions:

  • County Recruitment Team: 303-271-8400 or CareerTalent@Jeffco.us
  • Library Recruitment Team: 303.275.6168 or talent@jeffcolibrary.org
  • Sheriff Recruitment Team: 303.271.5332 or sheriff.recruiting@co.jefferson.co.us

Education:

Experience:

Work Experience: Minimum one year

Certifications:

Languages:

Category:

Health & Human Services