LPN - Utilization Review Nurse

High Point & Affiliated Organizations•New Bedford, MA

8h•$32 - $39•Onsite

About The Position

High Point & Affiliated Organizations is a health and human service agency whose mission is to treat and prevent substance use disorders and mental illness. High Point has programs located throughout Southeastern Massachusetts offering a full continuum of care for substance use and mental health treatment, including inpatient, outpatient, residential, and community-based services. Programs and services also assist survivors of abuse, violence, and families experiencing homelessness. High Point believes that everyone has inherent goodness, worth, and dignity. Our goal is to help individuals and families achieve personal change and improve their quality of life.

Requirements

Graduate of an Accredited Professional School or Nursing
Knowledge of ASAM criteria;
Managed care and utilization management experience;
Able to organize and structure own workload, attention to detail, and ability to maintain up to date tracking and filing systems;
Good clinical judgment, understanding of medical necessity and evidence-based practices;
Understanding of boundaries and ethics;
Possesses a pleasant telephone manner and customer service skills;
Good verbal and written communication skills;
The ability to work collaboratively with others in a collaborative and cooperative manner;
Understands the diseases of psychiatry and addictions and treatment modalities;
Presents professional at all times and allows for flexibility;
Problem solving abilities;
Critical thinking skills;
TB screening;
Certification in HPAO De-escalation training;
Knowledge of computer programs including Microsoft Office and Electronic Medical Records.

Nice To Haves

master's degree in social work, clinical psychology/counseling or mental health preferred.

Responsibilities

Maintains and submits any current Licensure or Certificate necessary for the performance of the position.
Compliance with Federal Regulations, 42 CFR Part II, Confidentiality of Alcohol and Drug Abuse Patients and HIPPA
Utilization management of all patients, ensuring proper authorization is obtained for all insured inpatient services;
Clinical reviews with insurance companies for continued stay, step downs to lower level of care and step ups to higher level of care (except IPU);
Responsible for assuring that the business office receives accurate billing information in a timely manner;
Keep counselors / nurses of insured patients updated as to their status;
Attend daily multi-disciplinary treatment team meetings;
Obtain necessary clinical, medical, and treatment information from clinical and medical staff to provide a comprehensive concurrent review;
Review all new admissions daily, verifying insurance eligibility, level of care, and obtaining all applicable authorizations;
Complete, discharge summary information to insurance companies when applicable;
Assist with admission approvals as needed;
Attend mandatory meetings and trainings;
Attend monthly departmental meetings;
Responsible for continued education in the field of substance abuse, nursing and related courses, when necessary;
Coordinate and support the initiation and completion of all appeal processes as necessary for insurance claim denials and/or retrospective reviews;
Provide assistance and support on the unit when necessary;
Utilizes standard precautions at all times;
Demonstrates behaviors that recognize the rights of patients as defined by the patient rights;
Other duties as assigned by the supervisor.