Utilization Review Nurse

Description

The Utilization Review Nurse is part of the Utilization Management Department at the Resnick Neuropsychiatric Hospital, supporting inpatient, partial hospital, and intensive outpatient programs. Performs clinical reviews with third party payors in order to obtain authorization, supporting the revenue cycle. Acts as a liaison between third party payors and the treatment team. Collaborates with financial counseling and the revenue cycle team. Follows up on payor denials and initiates appeals. Provides consultation to treatment team members regarding payor requirements. Completes required documentation within the electronic health record. Adheres to current organizational performance improvement priorities and takes action to improve practices and policies.

Qualifications

• BSN or MSN, required
• 5 years of psychiatric nursing care experience required.
• Current valid CA RN license, required
• BLS from the ARC or AHA, required.
• Prior case management experience, highly desired
• Proficient in Microsoft Office