Utilization Review RN — Behavioral Health Expert
Lighthouse Care Center of Augusta
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Benefits offered by this job
Job summary
Lighthouse Care Center of Augusta (LCCA) is a multi-discipline behavioral healthcare center serving children, adolescents and young adults in the Augusta, Georgia region. The Utilization Review Nurse will support the Director of Utilization Management with pre-certifications, stay reviews and coordination with treatment teams.
RN or LPN licensure is required with experience in psychiatric healthcare and utilization review.
Qualifications
- Current GA or Multistate RN or LPN license.
- 2 years of experience in psychiatric healthcare and utilization review.
- RN preferred or LPN license holder.
Responsibilities
- Review clinical content of medical records.
- Participate in treatment team meetings.
- Coordinate with physicians, therapists, nurses and staff to gather data for insurance pre-certifications and continued authorization.
- Input pre-certifications and stay reviews into Midas.
- Follow-up on unfinished pre-certifications from the day before.
- Coordinate with the treatment team on follow-ups as needed.
- Verify insurance coverage at the first of the month and post patient payments into MS4.
- Gather and enter clinical criteria into computer systems.
Skills
Education
Tools
Job description
Lighthouse Care Center of Augusta (LCCA) is a multi-discipline behavioral healthcare center serving children, adolescents and young adults in the Augusta, Georgia region. The Utilization Review Nurse will support the Director of Utilization Management with pre-certifications, stay reviews and coordination with treatment teams.
RN or LPN licensure is required with experience in psychiatric healthcare and utilization review.
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