Utilization Review Nurse (RN)

Lighthouse Care Center of Georgia, LLC; Augusta (GA); Hybrid; USD 70,000 - 95,000; Full time

Benefits offered by this job

Referral Bonus Program

Competitive compensation & generous PT

Excellent medical, dental, vision and

401(k) with company match

Job summary

Lighthouse Care Center of Augusta is seeking a dedicated Utilization Review Nurse, RN to join our behavioral health team in Augusta, GA. The role involves reviewing medical records, coordinating with treatment teams and payers to obtain precertifications and continued authorizations.

Ideal candidates have an RN or LPN license in GA, at least 2 years in psychiatric care, and familiarity with utilization review processes and data entry into Midas/MS4.

Qualifications

• RN or Licensed Practical Nurse with GA license
• 2 years in a psychiatric health care setting and utilization review
• Experience documenting clinical criteria and communicating with payers

Responsibilities

• Review clinical content of medical records
• Participate in treatment team meetings
• Collaborate with physicians, therapists, nurses and staff to gather data for approvals
• Enter pre-certifications and continued stay reviews into Midas
• Follow up on unfinished pre-certifications
• Coordinate with treatment team for follow-ups
• Verify insurance coverage at month start and post patient payments into MS4
• Input clinical criteria into computer systems
• Perform additional duties as assigned

Skills

Utilization Review

Education

RN or LPN license (GA or multistate)

Tools

Midas

MS4

Job description

Responsibilities

Lighthouse Care Center of Augusta is seeking a dedicated, compassionate Utilization Review Nurse, RN to add to our growing team.

Lighthouse Care Center of Augusta Lighthouse Care Center of Augusta (LCCA) is a multi-discipline behavioral healthcare center that offers mental health services to the communities of surrounding Augusta, Georgia. The Lighthouse Care Center of Augusta is an acute and residential treatment facility providing balanced, top-notch clinical care to children, adolescents and young adults. We provide a carefully-structured and supportive environment, and our education program is accredited through the Georgia Accrediting Commission. Utilization Review Nurse, RN Under the direction of the Director of Utilization Management.

Website: https://www.LighthouseCareCenters.com

Job Duties/ Responsibilities:

• Review clinical content of medical records
• Participate in treatment team meetings
• Collaborate with physicians, therapist, nurses and pertinent staff on gathering the necessary data to communicate with insurance companies/authorizing entities to ensure initial precertification and continued authorization is achieved
• Utilization Review/Business Office Coordinator will ensure input of pre-certifications and continued stay reviews into Midas
• Follow-up on unfinished pre-certifications from the day before
• Coordinate with the treatment team on any follow-ups necessary
• Verify insurance coverage at the first of the month, and post patient payments into MS4
• Trained in all aspects relative to timely gathering clinical criteria, communication of clinical criteria, and entry of supporting clinical criteria into computer based systems
• Additional job duties

Benefit Highlights:

• Referral Bonus Program
• Challenging and rewarding work environment
• Competitive Compensation & Generous Paid Time Off
• Excellent Medical, Dental, Vision and Prescription Drug Plans
• 401(K) with company match and discounted stock plan
• SoFi Student Loan Refinancing Program
• Career development opportunities within UHS and its 300+ Subsidiaries
• Pet Insurance
• More information is available on our Benefits Guest Website: uhsguest.com

About Universal Health Services:

Headquartered in King of Prussia, PA, Universal Health Services, Inc. (NYSE: UHS) is one of the nation’s largest and most respected providers of hospital and healthcare services. Since our founding in 1979, UHS has grown steadily into a premier Fortune 500® corporation perennially recognized by multiple esteemed national rating entities. Through its subsidiaries, UHS operates inpatient acute care facilities, inpatient behavioral health facilities, outpatient and other facilities, nationwide virtual behavioral health services, an insurance offering, a physician network and various related services with physical locations in the U.S., Puerto Rico, Ireland and United Kingdom. www.uhs.com.

Qualifications

Education and Experience:

• Registered Nurse (RN) preferred or License Professional Nurse (LPN)
• Current GA or Multistate Valid RN or LPN license
• Must have 2 years of experience in a psychiatric health care setting, delivery of care to psychiatric and/or chemically dependent patients and utilization review

EEO Statement:

All UHS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. UHS subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws.