LPN - Utilization Review Nurse

High Point & Affiliated Organizations

New Bedford (MA)

On-site

USD 44,000 - 54,000

Full time

14 days+

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Benefits offered by this job

Medical Insurance

Dental Insurance

Vision Insurance

Long & short term disability

Retirement plan (403b)

FSA & DSA

Employee Assistance Program

Bonuses & Referral

Free CEU classes for counselors or coo

Job summary

High Point & Affiliated Organizations is a health and human service agency dedicated to treating substance use disorders and mental illness. The UR Nurse role is based on-site in New Bedford, MA, with a Monday–Friday day shift and a pay range of $32–$39 per hour, dependent on experience, education, and licensure.

The ideal candidate has nursing credentials, familiarity with ASAM criteria, and UM experience to support insured inpatient services and concurrent reviews.

Qualifications

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 keep up-to-date tracking and filing systems.
Good clinical judgment, understanding of medical necessity and evidence-based practices.
Understanding of boundaries and ethics.
Posesses a pleasant telephone manner and customer service skills; strong verbal and written communication.
Ability to work collaboratively with others in a team.
Understands psychiatry and addictions and related treatment modalities.
Presents professional demeanor and flexibility; strong problem-solving and critical thinking.
TB screening; Certification in de-escalation training; EMR knowledge.

Responsibilities

Maintains and submits current licensure or certificate for the position.
Complies with Federal Regulations, 42 CFR Part II, Confidentiality of Alcohol and Drug Abuse Patients and HIPAA.
Manages utilization for all patients with proper authorization for insured inpatient services.
Conducts clinical reviews with insurance for continued stay and higher/lower levels of care.
Ensures the business office receives accurate billing information in a timely manner.
Keeps counselors and nurses updated on patient status.
Attends daily multidisciplinary treatment team meetings.
Obtains clinical and treatment information for concurrent review.
Reviews new admissions daily for insurance eligibility and authorizations.
Completes discharge summaries to insurers when applicable.
Assists with admission approvals as needed.
Attends mandatory meetings and trainings; monthly department meetings.
Coordinates and supports appeals for denials and retrospective reviews.
Provides unit support as needed.
Uses standard precautions at all times; respects patient rights.
Performs other duties as assigned by supervisor.

Skills

Computers & Office Software

ASAM criteria

Managed care & UM

Organization & detail

Clinical judgment

Boundaries & ethics

Verbal & written communication

Team collaboration

Psychiatry & addiction treatment

Professional demeanor & flexibility

TB screening & EMR knowledge

Education

Nursing degree

Master's in social work/psychology (preferred)

Job description

Program & Location: Central Utilization Review Department - New Bedford, MA

Qualifications: Graduate of an Accredited Professional School or Nursing or; master's degree in social work, clinical psychology/counseling or mental health preferred with experience in substance use and/or mental health services.

Pay Range: $32 - $39 per hour (experience, education & licensure dependent)

Status: Full Time, 40hrs/week

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

On-Site in New Bedford, MA

About Us

High Point & Affiliated Organizations is a health and human service agency whose mission is to treat and prevent substance use disorders and mental illness. High Point has programs located throughout Southeast Massachusetts offering a full continuum of care for substance use and mental health treatment, including inpatient, outpatient, residential, and community-based services. Programs and services also assist survivors of abuse, violence, and families experiencing homelessness. High Point believes that everyone has inherent goodness, worth, and dignity. Our goal is to help individuals and families achieve personal change and improve their quality of life.

UR Nurse Requirements

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.

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.