REPORTS TO:Quality Assurance Risk Management Director
The Colorado Equal Pay for Equal Work Act requires employers in the state of Colorado to disclose the following information. Hourly (salary) minimum $35.21, hourly (salary) maximum $41.87. The base hourly (salary) range above represents the low and high end of the range for this position. Actual hourly (salary) rates may be above or below the range based on various factors including but not limited to: experience, education, and training.
Pay is just one component to prospective employees’ compensation package. Compensation may also include shift differentials. In addition, Grand River Hospital District offers benefits including medical insurance coverage with prescription drug coverage, vision and dental insurance, medical and dependent care flexible spending accounts, life and accidental death and dismemberment insurance, disability, employee assistant programs, paid time off to cover family illness (sick time), holidays, personal business, vacation and other activities, extended illness benefits, 457 retirement plan with match, AFLAC, identity theft protection and pet insurance.
JOB PURPOSE:To improve the health and wellbeing of our communities.
BASIC FUNCTION: The Utilization Review (UR) Specialist has well-developed knowledge and skills in areas of utilization management (UM), medical necessity, and patient status determination for Inpatient, observation, and Swing Bed. This individual supports the UM program by developing and/or maintaining effective and efficient processes for determining the appropriate admission status based on the regulatory and reimbursement requirements of various commercial and government payers. This individual is responsible for performing a variety of concurrent and retrospective UM-related reviews and functions and for ensuring that appropriate data is tracked, evaluated, and reported. This individual monitors the effectiveness/outcomes of the UM program, identifying and applying appropriate metrics, evaluating the data, reporting results to various audiences, and designing and implementing process improvement projects as needed.
This individual identifies, develops, and provides orientation, training, and competency development for appropriate staff and colleagues on an ongoing basis. This individual leads and/or actively participates in process improvement initiatives, working with a variety of departments and multi-disciplinary staff. This individual maintains current and accurate knowledge regarding commercial and government payers and regulations/guidelines/criteria related to UM. This role is responsible for ensuring that the UM program maintains documented, up-to-date policies and procedures and ensures and that all UM key processes have valid outcome measures that are monitored for compliance and reported to a variety of audiences. The UR Specialist effectively and efficiently manages a diverse workload in a fast-paced, rapidly-changing regulatory environment. The UR Specialist facilitates the hospital’s UR Committee with UR Medical Provider member. Performs a variety of tasks and other duties as assigned.
Education:Graduation from an accredited school of Nursing. Active license in the State of Colorado as Registered Nurse. A temporary permit issued by the Board of Nursing will be accepted until a permanent license is received if awaiting reciprocity. Must have current BLS card upon hire and maintain current certification status throughout GRHD employment. Bachelor’s Degree preferred. ACM, CCM, Board Certification in Nursing Case Management, CPHQ preferred.
Experience:5 years overall nursing experience required. Recent experience as an inpatient utilization review nurse or UM coordinator preferred.
KNOWLEDGE, SKILLS AND ABILITIES:Strong understanding of and ability to use Statistical Process Control methods and programs including but not limited to SPSS, MiniTab and Statit. Working knowledge of equipment common to an office environment including multi-line phone system, fax, copier, etc. Knowledge of computer based programs including but not limited to Microsoft Office Suite and Meditech. Knowledge and proper use of grammar, spelling, punctuation, document proofing/formatting and basic math skills. Strong verbal and written communication skills and interpersonal skills required. Strong customer service skills required. Skilled in analyzing data and preparing reports including both statistical and narrative. Ability to learn computer based applications. Ability to demonstrate accuracy in processing detailed information. Ability to effectively multitask. Ability to maintain strict confidentiality of information. Ability to build and maintain effective working relationships with coworkers, patients, outside vendors and community members. Ability to identify problems and recommend solutions. Ability to communicate in English both verbally and in writing. Must be proficient within six (6) months of hire in Midas/statit, Kase, HealthStream, Kronos, Meditech, Allscripts ED, AllscriptsTouchworks, Galactica, Provider Portal, State Web Portal, QHN and Quality Net.
GENERAL COMPLIANCE REQUIREMENTS: Has knowledge of and adheres to all compliance regulations, policies and procedures. Completes annual compliance, privacy, and security training. Responsible for complying with all federal, state and local rules and regulations. Complies with the all Grand River Hospital District policies and procedures, the Code of Conduct and the Compliance and Ethics Program requirements. Reports any observation of fraud, waste, abuse, and/or privacy violations. Reports any conflict of interest or relationship immediately.
HEALTH INFORMATION PORTABILITY AND ACCOUNTABILITY ACT (HIPAA): Ensures and adheres to strict confidentiality when handling patient information, according to the HIPAA Privacy Act and hospital policy and procedure regarding confidentiality. Complies with all hospital information security practices.
PHYSICAL REQUIREMENTS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is occasionally required to stand, walk, sit, use the hands to finger, handle or feel objects, tools or controls; reach with hands and arms; climb stairs; balance; stoop, kneel, crouch; talk or hear; taste or smell. Must be able to lift and/or carry, push and/or pull up to 25 pounds. Specific vision abilities required by the job include close vision, distance vision, color vision, peripheral vision, depth perception and the ability to adjust focus.
WORKING CONDITIONS:There may be repetitive motions of the wrists and hands, extended periods of stationary activity and other conditions common to a clerical management position. The noise level in the work environment is usually low to moderate. Other conditions may exist which are common in a hospital and office environment.
Thank you for your interest in becoming a member of the Grand River Health team. Our employees enjoy best in class benefits; competitive, experience based pay and state of the art facilities and equipment. Our organization has experienced wonderful growth while preserving the family feel around campus.
Grand River Health includes our main hospital campus and our long term care center in Rifle, Colorado. We are also proud to offer services at our student health center and our satellite clinic in Parachute, Colorado.
The Western Slope of Colorado offers year round recreation with everything the outdoor enthusiast can imagine- all in a picturesque location on the Western Slope of Colorado. Big game hunting, fishing, golf, water sports, world-renowned rock and ice climbing, hiking, biking, snowmobiling and 4-wheeling: It’s all here for you. For those who enjoy the ski slopes- take in the world-class mountains of the Vail and Aspen valleys; just an hour East.
When it comes to caring for the well-being of our community, we at Grand River Health are always striving to improve as the lifelong partner in health for the residents of Rifle and its surrounding communities. We are v...ery pleased to have received a 5-Star rating for our care center and a 4-Star rating for the hospital from Centers for Medicaid and Medicare (CMS).
This keeps Grand River Health in the top 21% of hospitals in the nation and in the top 5% of long term care centers in the nation. In the spirit of continuous improvement we pursue a 5-Star rating for the hospital because we believe our community deserves only the best in their healthcare.
Grand River Health holds a strong belief that community health begins long before you ever see a physician. It is in what you eat, how you recreate, what resources are available to the community and how we, as a healthcare organization, support our community.
To review our open positions and submit your online application today, please visit www.grandriverhealth.org/jobs.
Also under the Career Opportunities section of our website, please check out our benefits and find out what it’s like to work at Grand River Health.
For general inquiries about a position, application assistance, or for more information contact our HR Team at 970-625-7356.