Utilization Review Nurse

N P H; Houston (TX); On-site; USD 80,000 - 110,000; Full time

Job summary

N P H is seeking a Utilization Review Nurse (RN) to coordinate patient services in their Clear Lake, Texas location. The role focuses on enhancing patient care through efficient health resource utilization and collaboration with medical teams. Candidates should possess strong skills in communication and time management, along with relevant nursing qualifications and experience.

Benefits

Competitive pay rates

Medical, Dental, and Vision Insurance

NPH 401(k) plan with up to 4% Company match

Generous PTO and Time Off Policy

Employee Assistance Program (EAP)

Tuition offers through Capella University

Employee Discounts through LifeMart

Qualifications

• 5+ years of utilization review experience in a hospital setting required.
• Registered Nurse (RN) or Licensed Practical Nurse (LPN) required.
• Certifications: Certified Case Manager (CCM) or Accredited Case Manager (ACM) preferred.

Responsibilities

• Coordinate patients’ services across the continuum of care.
• Promote effective utilization and monitor health resources.
• Collaborate with multidisciplinary teams.

Skills

Time management

Data entry

Communication

Attention to detail

Education

High School Diploma or GED

Associate Degree in Nursing

Bachelor or Masters of Science in Nursing

Job description

1 month ago Be among the first 25 applicants

HEALING THE BODY AND MIND

HEALING THE BODY AND MIND

Founded fifteen (15) years ago, NeuroPsychiatric Hospital is the largest hospital system in the nation providing care to patients with both neurological and medical needs. We are unique in that we serve a population which others have been previously been unable to, largely due the patient’s underlying medial issues. Our facilities maintain an inter-disciplinary focus using a multi-specialty approach for both neuropsychiatric and complex medical care issues. This proven approach provides unrivaled quality care for all of our patients. We have multiple locations throughout the United States and are continuing to add locations to ensure better access to our unique model of care.

Neuropsychiatric Hospitals is looking for a Utilization Review Nurse (RN) to coordinate patients’ services across the continuum of care by promoting effective utilization, monitoring health resources and elaborating with multidisciplinary teams. This will provide service to our utilization review team at our Clear Lake, Texas location.

Benefits Of Joining NPH

• Competitive pay rates
• Medical, Dental, and Vision Insurance
• NPH 401(k) plan with up to 4% Company match
• Employee Assistance Program (EAP) Programs
• Generous PTO and Time Off Policy
• Special tuition offers through Capella University
• Work/life balance with great professional growth opportunities
• Employee Discounts through LifeMart
• Filing documents as needed.
• Initial Precertification with payors.
• Concurrent Clinical review with payors.
• Document in the electronic system daily in real time.
• Admission audit.
• Ensures that CON’s/RON’s and CMS certifications are completed by provider.
• Consistently demonstrates professionalism with all internal and external customers as evidenced by positive customer and peer Communicates effectively with all staff and patients as evidenced by the establishment and maintenance of productive working relationships.
• Maintains knowledge of current trends and developments in the field by reading appropriate books; journals and other literature and attending related seminars or conferences.
• Maintains a professional approach with Assures protection and privacy of health information as attained through written, electronic or oral disclosures.
• Cooperates and maintains good rapport with nursing staff, medical staff, and other departments.
• Seeks guidance and remains knowledgeable of, and complies with, all applicable federal and state laws, as well as hospital polices that apply.
• Complies with hospital expectations regarding ethical behavior and standards of conduct.
• Complies with federal and hospital requirements in the areas of protected health information and patient information.
• Reconsiderations, assists with appeals as needed, arrange peer to peer level reviews, and report the outcomes to the VP of Care Management and Team.
• Provides education to nursing staff. leadership team, and providers regarding documentation.
• Actively works with the business office regarding resolution of appeals/denials and retrospective reviews.
  
  
  

Education High School Diploma or GED and graduate from an accredited LPN program or Associate Degree in Nursing required. Bachelor or Masters of Science in Nursing or Behavioral Health field preferred.

Experience Minimum of 5 years of utilization review experience in a hospital setting required. Minimum of 5 years of case management experience, including discharge planning in a hospital setting required.

Licensure Registered Nurse (RN) or Licensed Practical Nurse (LPN) in the state of RN required. Certified Case Manager (CCM), or Accredited Case Manager (ACM) preferred.

Skills Must have strong knowledge of medications and demonstrate exceptional time management, data entry, and communication skills. Must be detail oriented.

Seniority level

• Seniority level

  Mid-Senior level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Health Care Provider

• Industries

  Hospitals and Health Care

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