Utilization Review Nurse - Oxford Campus

Job ID
2022-6020
Job Locations
US-MS-Oxford
Posted Date
3 weeks ago(5/5/2022 2:10 PM)
Category
Nursing

Overview

Company Summary

If you are searching for a fulfilling place to develop your career and an opportunity to make a difference in helping others, then keep reading on. Here at AAC, we have a progressive culture; we listen to your ideas, value a work/life balance, invest in education, and we foster trust and respect for all individuals. Our exceptional comp and strong benefits include company matching 401K, medical, dental, vision and life insurance. We are looking for our future leaders, who are not only going to fill the qualifications for this job description, but who are going to exceed expectations. Be a part of a team whose mission is to provide quality, compassionate, and innovative care to adults struggling with addiction and co-occurring mental health disorders. Our purpose and passion are to empower patients, their families, and our communities by helping individuals achieve recovery and optimal wellness of the mind, body, and spirit.

Responsibilities

Job Summary

The UR Coordinator is responsible for case management and communicating census data to teams which in turn drives the level of care received by the clients. The UR Coordinator Lead will carry a case load and ensure the clients are covered at the appropriate level of care.

 

Duties and Responsibilities:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily.

The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

  • Send daily census data to clinical team and upload to Share Point for billing team.
  • Pre-certify new admission insurance clients with insurance companies.
  • Complete concurrent reviews for caseload to extend clients’ length of stay.
  • Communicate authorizations to clinical team to inform what level of care has been authorized for clients.
  • Communicate with the insurance department if a client does not have coverage or there are limitations on client’s policy that becomes available as case is opened with insurance company.
  • Work with clinical and client care team to communicate insurance case manager’s request for specific treatment, follow ups, and individualized care.
  • Ensure clinical documentation is in the EMR and follow up on any
  • missing documentation.
  • Complete doc to doc reviews as necessary.
  • Prepare for weekly meetings to discuss appropriate discharge dates based on authorizations.
  • Cover case load for UR team member as needed and complete concurrent reviews.
  • Assists UR manager with updating UR census data with new admissions/discharges and level of care (LOC).
  • Provide coverage for absent coworkers to ensure that days are not lost
  • Regular and consistent attendance is expected
  • Other Duties as assigned

Qualifications

Education/ Experience:

  • Requires Mississippi Registered Nurse (RN)
  • Previous experience working in UR preferred
  • Excellent verbal and written communication skills.
  • Ability to speak clearly and persuasively in positive or negative situations; listens and gets clarification; responds well to questions; demonstrates group presentation skills; and participates in meetings.
  • Excellent organizational and time management skills
  • Expertise in Addiction Disorders preferred
  • Microsoft Office software (Word, Excel, and Outlook) and ability to learn and use with very good proficiency electronic health record system.
  • Nonviolent Crisis Intervention training within 30 days of hire
  • CPR certification within 30 days of hire

Physical Requirements

AAC is committed to principles of equal opportunities for all employees.  The Company will provide reasonable accommodations that are necessary to comply with State and Federal disability discrimination laws

  • Prolonged sitting at a desk
  • Must be able to lift 15 pounds at a time

Certifications and Licenses:

  • Requires Registered Nurse (RN)

Other Work Requirements:

  • This position does not require extended travel. However, incumbents may be required to work at facilities other than the home facility.
  • Must be willing to work flexible hours including weekends and holidays

American Addiction Centers is an equal opportunity employer.  American Addiction Centers prohibits employment practices that discriminate against individuals or groups of employees on the basis of age, color disability, national origin, race, religion, sex, sexual orientation, pregnancy, veteran or military status, genetic information or any other category deemed protected by state and/or federal law.

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