RN Utilization Review Clinician — Psychiatric Care

Universal Health Services; Westwood (GA); On-site; USD 65,000 - 85,000; Full time

Benefits offered by this job

Referral Bonus Program

Competitive compensation

Generous paid time off

Medical, dental, vision plans

401(K) with company match

Career development opportunities

Job summary

Lighthouse Care Center of Augusta is seeking a dedicated Utilization Review Nurse to join our multidisciplinary behavioral health team in Augusta, GA. The position involves reviewing clinical records, coordinating with physicians and staff, and securing initial precertifications and continued authorizations with insurers.

Under the Director of Utilization Management, the role requires GA RN/LPN licensure and 2+ years in psychiatric care with UR experience.

Qualifications

• RN or LPN license in GA, or multistate license.
• Minimum 2 years in psychiatric healthcare setting.
• Experience with utilization review processes.

Responsibilities

• Review clinical content of medical records.
• Participate in treatment team meetings.
• Communicate with insurance companies to obtain precertifications and authorizations.
• Enter pre-certifications and stay reviews into Midas system.
• Follow up on unfinished pre-certifications from the previous day.
• Coordinate with treatment team for follow-ups.
• Verify insurance coverage and post patient payments as applicable.
• Gather and input clinical criteria into computer systems.

Skills

Psychiatric care experience

Utilization review experience

Education

RN license GA or multistate

LPN license GA or multistate

Job description

Lighthouse Care Center of Augusta is seeking a dedicated Utilization Review Nurse to join our multidisciplinary behavioral health team in Augusta, GA. The position involves reviewing clinical records, coordinating with physicians and staff, and securing initial precertifications and continued authorizations with insurers.

Under the Director of Utilization Management, the role requires GA RN/LPN licensure and 2+ years in psychiatric care with UR experience.