LPN - Utilization Review Nurse

About the role

High Point & Affiliated Organizations is a health and human service agency committed to treating and preventing substance use disorders and mental illness. We offer a range of programs across Southeastern Massachusetts, including inpatient, outpatient, residential, and community-based services, as well as support for survivors of abuse, violence, and families experiencing homelessness.

Qualifications

• Graduate of an Accredited Professional School or Nursing
• Master's degree in social work, clinical psychology/counseling, or mental health preferred

Pay

$32 - $39 per hour (dependent on experience, education, and licensure)

Status

Full Time, 40 hours/week

Shift

Monday-Friday 7:30am-4:00pm

Location

On-site in New Bedford, MA

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
• Presents problem-solving abilities
• Presents 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

Benefits

• Medical Insurance
• Dental Insurance
• Vision Insurance
• Long & short term disability
• Discounted auto/home and renters insurance
• 403(b) - Retirement
• FSA & DSAP
• MLA
• 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)