Utilization Review Nurse

Neuropsychiatric Hospitals•Crown Point, IN

3h•Onsite

About The Position

Neuropsychiatric Hospitals is looking for a Utilization Review Nurse (RN) to coordinate patients’ services across the continuum of care by promoting effective utilization, monitoring health resources and elaborating with multidisciplinary teams. This will provide service to our utilization review team at our Crown Point location.

Requirements

High School Diploma or GED and graduate from an accredited LPN program or Associate Degree in Nursing required.
Minimum of 2 years of utilization review experience in a hospital setting required.
Minimum of 2 years of case management experience, including discharge planning in a hospital setting required.
Registered Nurse (RN) or Licensed Practical Nurse (LPN) in the state of Indiana required.
Must have strong knowledge of medications and demonstrate exceptional time management, data entry, and communication skills.
Must be detail oriented.

Nice To Haves

Bachelor or Masters of Science in Nursing or Behavioral Health field preferred.
Certified Case Manager (CCM), or Accredited Case Manager (ACM) preferred.

Responsibilities

Filing documents as needed.
Initial Precertification with payors.
Concurrent Clinical review with payors.
Document in the electronic system daily in real time.
Admission audit.
Ensures that CON’s/RON’s and CMS certifications are completed by provider.
Consistently demonstrates professionalism with all internal and external customers as evidenced by positive customer and peer Communicates effectively with all staff and patients as evidenced by the establishment and maintenance of productive working relationships.
Maintains knowledge of current trends and developments in the field by reading appropriate books; journals and other literature and attending related seminars or conferences.
Maintains a professional approach with Assures protection and privacy of health information as attained through written, electronic or oral disclosures.
Cooperates and maintains good rapport with nursing staff, medical staff, and other departments.
Seeks guidance and remains knowledgeable of, and complies with, all applicable federal and state laws, as well as hospital polices that apply.
Complies with hospital expectations regarding ethical behavior and standards of conduct.
Complies with federal and hospital requirements in the areas of protected health information and patient information.
Reconsiderations, assists with appeals as needed, arrange peer to peer level reviews, and report the outcomes to the VP of Care Management and Team.
Provides education to nursing staff. leadership team, and providers regarding documentation.
Actively works with the business office regarding resolution of appeals/denials and retrospective reviews.