What are the responsibilities and job description for the LPN Utilization Review Nurse position at High Point & Affiliated Organizations?
UR Nurse Requirements: Knowledge of ASAM criteria; Managed care and
utilization management experience; Able to organize and structure own
workload, attention to detail, and ability to maintain up to date
tracking and filing systems; Good clinical judgment, understanding of
medical necessity and evidence-based practices; Understanding of
boundaries and ethics; Possesses a pleasant telephone manner and
customer service skills; Good verbal and written communication skills;
The ability to work collaboratively with others in a collaborative and
cooperative manner; Understands the diseases of psychiatry and
addictions and treatment modalities; Presents professional at all times
and allows for flexibility; Problem solving abilities; Critical thinking
skills; TB screening; Certification in HPAO De-escalation training;
Knowledge of computer programs including Microsoft Office and Electronic
Medical Records. UR Nurse Duties and Responsibilities: Maintains and
submits any current Licensure or Certificate necessary for the
performance of the position. Compliance with Federal Regulations, 42 CFR
Part II, Confidentiality of Alcohol and Drug Abuse Patients and HIPPA
Utilization management of all patients, ensuring proper authorization is
obtained for all insured inpatient services; Clinical reviews with
insurance companies for continued stay, step downs to lower level of
care and step ups to higher level of care (except IPU); Responsible for
assuring that the business office receives accurate billing information
in a timely manner; Keep counselors / nurses of insured patients updated
as to their status; Attend daily multi-disciplinary treatment team
meetings; Obtain necessary clinical, medical, and treatment information
from clinical and medical staff to provide a comprehensive concurrent
review; Review all new admissions daily, verifying insurance
eligibility, level of care, and obtaining all applicable authorizations;
Complete, discharge summary information to insurance companies when
applicable; Assist with admission approvals as needed; Attend mandatory
meetings and trainings; Attend monthly departmental meetings;
Responsible for continued education in the field of substance abuse,
nursing and related courses, when necessary; Coordinate and support the
initiation and completion of all appeal processes as necessary for
insurance claim denials and/or retrospective reviews; Provide assistance
and support on the unit when necessary; Utilizes standard precautions at
all times; Demonstrates behaviors that recognize the rights of patients
as defined by the patient rights; Other duties as assigned by the
supervisor.
utilization management experience; Able to organize and structure own
workload, attention to detail, and ability to maintain up to date
tracking and filing systems; Good clinical judgment, understanding of
medical necessity and evidence-based practices; Understanding of
boundaries and ethics; Possesses a pleasant telephone manner and
customer service skills; Good verbal and written communication skills;
The ability to work collaboratively with others in a collaborative and
cooperative manner; Understands the diseases of psychiatry and
addictions and treatment modalities; Presents professional at all times
and allows for flexibility; Problem solving abilities; Critical thinking
skills; TB screening; Certification in HPAO De-escalation training;
Knowledge of computer programs including Microsoft Office and Electronic
Medical Records. UR Nurse Duties and Responsibilities: Maintains and
submits any current Licensure or Certificate necessary for the
performance of the position. Compliance with Federal Regulations, 42 CFR
Part II, Confidentiality of Alcohol and Drug Abuse Patients and HIPPA
Utilization management of all patients, ensuring proper authorization is
obtained for all insured inpatient services; Clinical reviews with
insurance companies for continued stay, step downs to lower level of
care and step ups to higher level of care (except IPU); Responsible for
assuring that the business office receives accurate billing information
in a timely manner; Keep counselors / nurses of insured patients updated
as to their status; Attend daily multi-disciplinary treatment team
meetings; Obtain necessary clinical, medical, and treatment information
from clinical and medical staff to provide a comprehensive concurrent
review; Review all new admissions daily, verifying insurance
eligibility, level of care, and obtaining all applicable authorizations;
Complete, discharge summary information to insurance companies when
applicable; Assist with admission approvals as needed; Attend mandatory
meetings and trainings; Attend monthly departmental meetings;
Responsible for continued education in the field of substance abuse,
nursing and related courses, when necessary; Coordinate and support the
initiation and completion of all appeal processes as necessary for
insurance claim denials and/or retrospective reviews; Provide assistance
and support on the unit when necessary; Utilizes standard precautions at
all times; Demonstrates behaviors that recognize the rights of patients
as defined by the patient rights; Other duties as assigned by the
supervisor.