Utilization Review Nurse (LPN) – Substance Use & Mental Health

High Point & Affiliated Organizations; New Bedford (MA); On-site; USD 44,000 - 54,000; Full time

Benefits offered by this job

Health Insurance

Vision Insurance

Long & short term disability

401k/Retirement plan

Employee Assistance Program

CEU education days

Job summary

High Point & Affiliated Organizations is seeking a Universal RN for the Central Utilization Review Department in New Bedford, MA. The role emphasizes utilization management, insurance authorizations, and clinical reviews in substance use and mental health care.

Qualified candidates will have nursing, preferred master’s in social work/psychology, and experience with ASAM criteria and managed care. On-site position with full-time hours and comprehensive benefits in a supportive, mission-driven

Qualifications

• Requires nursing degree or equivalent; master’s preferred in social work/psychology/mental health with substance use/mental health experience.
• ASAM criteria knowledge and managed care experience are required.
• Proficient computer skills including Word, email, and EMR systems.

Responsibilities

• Submit licensure/certifications for position maintenance.
• Ensure compliance with Federal regs and HIPAA.
• Manage utilization review, authorizations, and insurance follow-up.
• Coordinate with treatment teams and providers for admissions and discharges.
• Assist with appeals and case documentation as needed.
• Attend mandatory meetings and trainings.
• Uphold patient rights and confidentiality.

Skills

ASAM criteria

Managed care

Customer service

Verbal & written communication

Team collaboration

Medical necessity

Ethics & boundaries

Problem solving

Critical thinking

Education

Nursing degree

Master's degree in social work/psychology/mental health

Tools

Microsoft Word

Email

Electronic Medical Records (EMR)

Microsoft Office

Job description

High Point & Affiliated Organizations is seeking a Universal RN for the Central Utilization Review Department in New Bedford, MA. The role emphasizes utilization management, insurance authorizations, and clinical reviews in substance use and mental health care.

Qualified candidates will have nursing, preferred master’s in social work/psychology, and experience with ASAM criteria and managed care. On-site position with full-time hours and comprehensive benefits in a supportive, mission-driven