LPN - Utilization Review Nurse

LPN - Utilization Review Nurse 

• Proficiency with computers, Microsoft Word, email, typing, and other basic office technology. 
• 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.

• →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.