RN Psychiatric Utilization Review Nurse Position Available In Oswego, New York

RN Psychiatric Utilization Review Nurse 2.9 2.9 out of 5 stars 110 West 6th Street, Oswego, NY 13126

Job Title:

Utilization Review Nurse Department:

Case Management Reports to:

Theresa FitzGibbons Revision Date:

3/31/2025

Job Summary:

Assess and manage mental health services to ensure, and insurance appropriate, cost effective care, reviewing patient needs, treatment plans, and insurance coverage, while collaborating with healthcare professionals to optimize patient outcomes.

Duties/Responsibilities:

Perform accurate assessments; initiate, implement and evaluate the UR plan and alter as needed. Maintain a current Utilization Review Plan in accordance with state and federal regulation. Participate in development and update of criteria specific to readmission, concurrent, focused and retrospective reviews. Process documents needed for level of care changes (ie. Denial, reinstatements) according to regulations for hospital and ALC patients. Perform reviews on units as directed by manager for inpatient, Children Services, CDT and ACT. Perform reviews for Psych Acute and ALC residents, and all outpatient services for level of care and insurance, including readmission and concurrent. Coordinate off-site and on-site reviews by third party payers, government review agencies and other outside agencies. Coordinate prompt completion and verification of information for billing purposes. Coordinate, process and track all reconsiderations and appeals to maximize reimbursement. Assist physicians and Finance Division as requested for appeals, reconsideration or interpretation of the state and federal guidelines for UR. Communicate with Departments regarding requirements for the UR component of managed care contracts and trends in UR and quality improvement. Maintain accurate and current documentation in the medical record, case files, records, forms and logs as indicated. Evaluate patient records, treatment plans, and insurance coverage to determine the appropriateness of mental health services. Work with physicians, therapists, and other healthcare providers to optimize efficiencies and maintain high quality of care Adapt to the different needs of patients from child to geriatric with respect to their total care. “Perform other duties as assigned.” Required Skills/Abilities (Unit Specific): Communicate regularly with assigned provider, appropriate nurses, patients and families, to assure appropriate length of stay, cost containment and proper utilization of resources. Handle telephone information with courtesy, accuracy and respect for confidentiality; receive information and distribute messages appropriately. Work effectively and communicate frequently with members of the health care team. Provide accurate communication in verbal, nonverbal and written form; utilize effective listening skills Maintain a current Utilization Review Plan in accordance with state and federal regulation

Education and Experience:

Graduate of an approved RN program, and current licensure in NYS required. Bachelor degree in preferred. Minimum of 5 years’ clinical experience required. Demonstrated competence in utilization review, quality improvement, general health care financial management, and computer skills preferred.

Working Conditions:

Ability to stand for extended periods of time, ability to life twenty (20) pounds. Moving, lifting or transferring of patients may involve lifting up to fifty (50) pounds Assist with weights of more than one-hundred (100) pounds, fine motor skills, visual acuity.

Pay Range:

$35.00-$41.20/hour Employee salary is based on commensurate experience and other qualifications. The mission of Oswego Health is to provide accessible, quality care and improve the health of residents throughout Oswego County. As a nonprofit healthcare system that was established in 1881, Oswego Health is proud to continue to be one of Oswego County’s largest employers. More than 1,200 employees spread throughout its 17 locations, work for the Oswego Health system, which includes the 164-bed community hospital with a brand new Medical Surgical Unit, a 32-bed state-of-the-art psychiatric acute-care facility with multiple outpatient behavioral health service locations, The Manor at Seneca Hill, a 120-bed skilled nursing facility, and Springside at Seneca Hill, an independent retirement community. The health system also operates Oswego Health Home Care, the only hospital-based certified home healthcare agency in the County as well as two outpatient centers, including the Fulton Medical Center, offering urgent care, lab, medical imaging, physical therapy, and occupational health services; and the Central Square Medical Center, offering urgent care, lab, medical imaging, and physical therapy services. In addition, Oswego Health includes the Oswego Health captive professional corporation, Physician Care P.C., providing physician services in orthopedics, cardiology, ENT, gastroenterology, breast care, audiology, general surgery, bariatrics, and primary care.

EQUAL EMPLOYMENT OPPORTUNITY

Oswego Health is committed to providing equal opportunity in all employment-related matters, without regard to race (including traits historically associated with race), creed, color, religion, sex/gender, national origin, age, marital or familial status, disability, pregnancy-related condition, sexual orientation, gender identity, gender expression, transgender status, citizenship status, ancestry, arrest/conviction record, military or veteran status, domestic violence victim status, genetic predisposition or carrier status, reproductive health decision making, relationship or association with a member of a protected category, or any other legally protected characteristic. Decisions affecting your position including, but not limited to, recruitment, hiring, placement, promotion, transfer, compensation, benefits, training, tuition assistance, leaves of absence, disciplinary action, layoff/recall, and terminations will be made in accordance with this policy.