Utilization Review RN - Behavioral Health Focus

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

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.