Mental Health RN - Utilization Review & Care Coordination

WVU Medicine; New York (NY); On-site; USD 65,000 - 90,000; Full time

Job summary

USC Healthy Minds in Weston, WV seeks a qualified RN for the ACT Program to coordinate utilization review activities and assess medical necessity at admission. The role involves supervising nursing staff, ensuring documentation quality, and collaborating with payers for timely certification and reimbursement.

The position requires an active RN license, BLS within 30 days, and at least two years of mental health experience; one year of utilization review is preferred.

Qualifications

• Two years clinical experience in mental health.

Responsibilities

• Initial clinical assessment on admission to determine medical necessity.
• Concurrent and retrospective reviews with third party payers.
• Coordinate certification process for proper reimbursement and associated paperwork.
• Educate house staff on documentation techniques.
• Act as liaison with third party payers and regulatory agencies.
• Ensure medical records meet hospital and accrediting agency standards.
• Protect confidentiality of all clinical data.
• Coordinate quality assurance activities related to patient care and treatment planning.
• Engage in ongoing professional development in utilization review standards.

Skills

Utilization review

Clinical assessment

Nursing care

Staff education

Education

RN license (state or eNLC)

BLS within 30 days

Background check required

Job description

USC Healthy Minds in Weston, WV seeks a qualified RN for the ACT Program to coordinate utilization review activities and assess medical necessity at admission. The role involves supervising nursing staff, ensuring documentation quality, and collaborating with payers for timely certification and reimbursement.

The position requires an active RN license, BLS within 30 days, and at least two years of mental health experience; one year of utilization review is preferred.