LPN - Utilization Review Nurse

• 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;
• Other duties as assigned by the supervisor.

UR Nurse Qualifications

• Licensed Practical Nurse;
• Substance Abuse Experience recommended.