Utilization Review Nurse

About Us

HEALING THE BODY AND MIND

Founded fifteen (15) years ago, NeuroPsychiatric Hospital is the largest hospital system in the nation providing care to patients with both neurological and medical needs. We serve a population that others have been unable to due to the patients' underlying medical issues. Our facilities maintain an inter-disciplinary focus using a multi-specialty approach for both neuropsychiatric and complex medical care issues. This proven approach provides unrivaled quality care for all of our patients. We have multiple locations throughout the United States and are continuing to add locations to ensure better access to our unique model of care.

Overview

Neuropsychiatric Hospitals is looking for a Utilization Review Nurse (RN) to coordinate patients’ services across the continuum of care by promoting effective utilization, monitoring health resources, and collaborating with multidisciplinary teams. This role will provide service to our utilization review team at our Bremen location.

Benefits of joining NPH

• Competitive pay rates
• Medical, Dental, and Vision Insurance
• NPH 401(k) plan with up to 4% Company match
• Employee Assistance Program (EAP)
• Generous PTO and Time Off Policy
• Special tuition offers through Capella University
• Work/life balance with great professional growth opportunities
• Employee Discounts through LifeMart

Responsibilities

• Filing documents as needed.
• Initial precertification with payors.
• Concurrent clinical review with payors.
• Documenting in the electronic system daily in real time.
• Conducting admission audits.
• Ensuring that CONs/RONs and CMS certifications are completed by the provider.
• Demonstrating professionalism with all internal and external customers.
• Communicating effectively with all staff and patients.
• Maintaining knowledge of current trends and developments in the field.
• Assuring protection and privacy of health information.
• Cooperating and maintaining good rapport with nursing staff, medical staff, and other departments.
• Complying with all applicable federal and state laws, as well as hospital policies.
• Adhering to hospital expectations regarding ethical behavior and standards of conduct.
• Assisting with reconsiderations and appeals as needed.
• Providing education to nursing staff, leadership team, and providers regarding documentation.
• Working with the business office regarding resolution of appeals/denials and retrospective reviews.

Qualifications

Education: Must have graduated from an accredited school of nursing.

Licensure: Registered Nurse (RN) or Licensed Practical Nurse (LPN) in the state of Indiana required.

Skills: Strong knowledge of medications, exceptional time management, data entry, and communication skills. Must be detail-oriented.