LPN - Utilization Review Nurse

LPN - Utilization Review Nurse 

Program & Location: Central Utilization review Department - New Bedford

Education/Licensure: Licensed Practical Nurse

Pay Range: $34 - $41 per hour

Status: Full Time, 40 hours

Shift: Monday thru Friday 7:30AM - 4PM

Substance Abuse and ASAM Knowledge preferred but not required

Benefits:

• Medical Insurance 
• Dental Insurance
• Vision Insurance
• Long & short term disability
• Discounted auto/home and renters insurance 
• 403b - Retirement
• FSA & DSA
• PMLA
• Employee Assistance Program
• Bonuses & Referral
• Eligibility for free classes to become a Licensed Counselor or Recovery Coach
• Education days to use towards CEU's
• Free meals at select programs and when available
• Unmatched Leave Time (FT employees can earn up to 3 weeks in first year)

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. 

UR Nurse Requirements: 

• Knowledge of ASAM criteria; 
• Managed care and utilization management experience; 
• Able to organize and structure own work load, 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; 
• TB screening. 

UR Nurse Duties and 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 assuring that all insured patients are authorized for all inpatient treatment;  
• 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, complete authorization form and verify authorization status;  
• Complete, provide and FAX discharge summary information to insurance companies when requested; 
• Complete three page authorization forms entirely; 
• Assist with admission approvals as needed; 
• Attend mandatory meetings and trainings; 
• Attend monthly billing meetings; 
• Responsible for continued education in the field of substance abuse, nursing and related courses, when necessary; 
• Assist with scheduling and follow up of MD to MD reviews when requested by insurance companies; 
• 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. 

UR Nurse Qualifications: 

• Licensed Practical Nurse;
• Substance Abuse Experience recommended.