Utilization Review Nurse

Location: Pennsylvania - Eagleville
Duration: Full Time
Job ID: 975 (22396305)
Category: Risk Management RN Job
Company: ProEnlist
Contact: April Estes    Call: 7204392609
Practice Type:   Private
Job Salary:   Competitive
Job Posted: 01/26/21

Utilization Review Nurse - 975 (22396305)

Position Overview: 
This is an onsite position and does not currently allow for remote work.  Position can be in Eagleville, PA or Norristown, PA.

Responsibilities:

  • Reviews admissions to determine medical necessity and appropriateness of treatment.
  • Secures necessary data for extended stay reviews.
  • Presents abstract (via telecon) of clinical course of treatment, to all various insurance companies and/or their contractual agencies, to justify continued treatment.
  • Reviews, abstracts and assigns initial length of stay and extensions of treatment, as appropriate, for Medicare, self-pay and private (non-precertification) insurance companies.
  • Communicates all extensions of treatment to clinical teams and Director, Utilization Review.
  • Attends daily treatment team meetings.

 

 



Required Qualifications: 

  • Graduate of accredited school of nursing; Bachelor's preferred.
  • Previous UR experience required
  • Previous experience in a behavioral health setting preferred
  • Requires good writing skills along with the ability to interpret chart terminology
  • Knowledge of addiction helpful