LPN Utilization Review 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

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
• 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
• Cookordination 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