LPN Utilization Review Nurse Position Available In Bristol, Massachusetts

UR Nurse Requirements:

Knowledge of ASAM criteria; Managed care andutilization management experience; Able to organize and structure ownwork load, attention to detail, and ability to maintain up to datetracking and filing systems; Good clinical judgment, understanding ofmedical necessity and evidence-based practices; Understanding ofboundaries and ethics; Possesses a pleasant telephone manner andcustomer service skills; Good verbal and written communication skills;The ability to work collaboratively with others in a collaborative andcooperative manner; Understands the diseases of psychiatry andaddictions and treatment modalities; Presents professional at all timesand allows for flexibility; Problem solving abilities; TB screening.

URNurse Duties and Responsibilities:

Maintains and submits any currentLicensure or Certificate necessary for the performance of the position.

Compliance with Federal Regulations, 42 CFR Part II, Confidentiality ofAlcohol and Drug Abuse Patients and HIPPA Utilization management of allpatients assuring that all insured patients are authorized for allinpatient treatment; Clinical reviews with insurance companies forcontinued stay, step downs to lower level of care and step ups to higherlevel of care (except IPU); Responsible for assuring that the businessoffice receives accurate billing information in a timely manner; Keepcounselors / nurses of insured patients updated as to their status;Attend daily multi-disciplinary treatment team meetings; Obtainnecessary clinical, medical, and treatment information from clinical andmedical staff to provide a comprehensive concurrent review; Review allnew admissions daily, complete authorization form and verifyauthorization status; Complete, provide and FAX discharge summaryinformation to insurance companies when requested; Complete three pageauthorization forms entirely; Assist with admission approvals as needed;Attend mandatory meetings and trainings; Attend monthly billingmeetings; Responsible for continued education in the field of substanceabuse, nursing and related courses, when necessary; Assist withscheduling and follow up of MD to MD reviews when requested by insurancecompanies; Provide assistance and support on the unit when necessary;Utilizes standard precautions at all times; Demonstrates behaviors thatrecognize the rights of patients as defined by the patient rights; Otherduties as assigned by the supervisor.

UR Nurse Qualifications:

LicensedPractical Nurse; Substance Abuse Experience recommended.