Job Posting for LPN - Utilization Review Nurse at High Point & SEMCOA Job Board
LPN - Utilization Review Nurse
Program & Location: Central Utilization review Department - New Bedford Education/Licensure: Licensed Practical Nurse Pay Range: $32 - $37 per hour Status: Full Time, 40 hours Shift: Monday thru Friday 7:30AM - 4PM Substance Abuse Experience recommended
Benefits:
Medical Insurance
Dental Insurance
Vision Insurance
Long & short term disability
Discounted auto/home and renters insurance
403b - Retirement
FSA & DSA
PMLA
Employee Assistance Program
Bonuses & Referral
Eligibility for free classes to become a Licensed Counselor or Recovery Coach
Education days to use towards CEU's
Free meals at select programs and when available
Unmatched Leave Time (FT employees can earn up to 3 weeks in first year)
High Point & Affiliated Organizations is a health and human service agency whose mission is to treat and prevent substance use disorders and mental illness. High Point has programs located throughout Southeastern Massachusetts offering a full continuum of care for substance use and mental health treatment, including inpatient, outpatient, residential, and community-based services. Programs and services also assist survivors of abuse, violence, and families experiencing homelessness. High Point believes that everyone has inherent goodness, worth, and dignity. Our goal is to help individuals and families achieve personal change and improve their quality of life.
UR Nurse Requirements:
Knowledge of ASAM criteria;
Managed care and utilization management experience;
Able to organize and structure own work load, 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;
TB screening.
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 assuring that all insured patients are authorized for all inpatient treatment;
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, complete authorization form and verify authorization status;
Complete, provide and FAX discharge summary information to insurance companies when requested;
Complete three page authorization forms entirely;
Assist with admission approvals as needed;
Attend mandatory meetings and trainings;
Attend monthly billing meetings;
Responsible for continued education in the field of substance abuse, nursing and related courses, when necessary;
Assist with scheduling and follow up of MD to MD reviews when requested by insurance companies;
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;
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