LPN Utilization Review Nurse

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.