Utilization Review Nurse (RN)- FT Nights

Utilization Review Registered Nurse- FT Nights, 5-8 hour shifts- Sunday through Thursday ESSENTIAL DUTIES :

• Immediately respond to all Bluestone Intak email, faxes and phone calls.
• Review all referrals for clinical appropriateness within 10 minutes of receipt, except during approved break times.
• Contact the provider on call within 10 minutes of the completed review of the referral.
• Facilitate the admission with the referring hospital, including completing the nurse-to-nurse call, creating a new patient admission in the electronic medical record and entering all treatment orders and medications.
• Complete initial, concurrent, and retrospective reviews of patient care in a timely manner to ensure continuous coverage for patients in inpatient treatment.
• Initiate, schedule, and meaningfully participate in peer reviews and expedited appeals between third-party payers and facilities as needed.
• Maintain sophisticated and current knowledge of mental health disorders including DSM-V knowledge, ICD-10 diagnoses and treatment processes.
• Utilize clinical information and knowledge of medical necessity criteria to effectively communicate plans of care to insurance case managers, facility staff, and healthcare partners including the admitting psychiatrist.
• Collaborate with the treatment team to discuss clinical authorization and quality of care.
• Consistent and timely response to emails and other communications relating to utilization review.
• Prepare and submit appeals utilizing their independent knowledge and expertise.
• Familiarity with processing correspondence with adherence to HIPAA guidelines.
• Complete all data tracking as needed.
• Perform all duties of the Psychiatric Nurse (RN) role as needed or when assigned by management.

OTHER DUTIES :

QUALIFICATIONS :

Bachelor’s or Master’s degree in related field preferred.  Licensure :

Skills :

Experience :

Our offerings include :

Wellness program including free preventative care Generous paid time off and holidays 50% tuition reduction at Case Western Reserve University for the MNO and MSW programs 403(b) retirement plan with an employer match Pet insurance Employer paid life insurance and long-term disability Employee Assistance Program Support for continuing education and credential renewal Ancillary benefits including :