Behavioral Health Utilization Review Nurse RN New

Description

Introduction

Do you have the career opportunities as a Behavioral Health Utilization Review Specialist you want with your current employer? We have an exciting opportunity for you to join Parallon which is part of the nation's leading provider of healthcare services, HCA Healthcare.

Benefits

Parallon, offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and programs include:

• Comprehensive medical coverage that covers many common services at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services and free AirMed medical transportation.
• Additional options for dental and vision benefits, life and disability coverage, flexible spending accounts, supplemental health protection plans (accident, critical illness, hospital indemnity), auto and home insurance, identity theft protection, legal counseling, long-term care coverage, moving assistance, pet insurance and more.
• Free counseling services and resources for emotional, physical and financial wellbeing
• 401(k) Plan with a 100% match on 3% to 9% of pay (based on years of service)
• Employee Stock Purchase Plan with 10% off HCA Healthcare stock
• Family support through fertility and family building benefits with Progyny and adoption assistance.
• Referral services for child, elder and pet care, home and auto repair, event planning and more
• Consumer discounts through Abenity and Consumer Discounts
• Retirement readiness, rollover assistance services and preferred banking partnerships
• Education assistance (tuition, student loan, certification support, dependent scholarships)
• Colleague recognition program
• Time Away From Work Program (paid time off, paid family leave, long- and short-term disability coverage and leaves of absence)
• Employee Health Assistance Fund that offers free employee-only coverage to full-time and part-time colleagues based on income.
  
  

Learn More About Employee Benefits

Note: Eligibility for benefits may vary by location.

Our teams are a committed, caring group of colleagues. Do you want to work as a Behavioral Health Utilization Review Specialist where your passion for creating positive patient interactions is valued? If you are dedicated to caring for the well-being of others, this could be your next opportunity. We want your knowledge and expertise!

Job Summary And Qualifications

This position will focus on Notice of Admission (NOA), initial and continued stay utilization review and discharge reviews as needed for authorization procurement and mitigation of concurrent denials. This involves assessment of medical records for appropriateness and level of care provided, including assessment of treatment modalities, medications, services, and application of treatment protocols. Remain current with HCA education standards and guidelines, such as annual InterQual education, ongoing Midas education and Midas worklist rules. Maintain Nursing or Master Social Work / Counseling appropriate licensure for assigned geographical market and productivity.

In this role you will:

• Conduct medical record review, validate admission status order, conduct a medical necessity review and provide clinical information to payor
• Document all efforts to gain authorization and payor communications, confirming all days authorized or denied and document in Midas
• Utilize critical thinking skills to review and apply medical necessity criteria
• Proficient in application and use of InterQual
• Analyze documentation of clinical care from the electronic medical record
• Exhibit determined and assertive verbal and written communication skills when interacting with payors
• Demonstrate knowledge and effective use of multiple applications, systems and resources including, but not limited to: Call Recording, WebEx Teams, Electronic Health Records, Payor portals, Right Fax, Share Point sites and On base
• Communicate with physicians regarding patient status, clinical documentation, and concurrent denial mitigation strategies
• Practice adherence to HCA BH URS guidelines and practice standards
• Ability to work independently, show initiative and work with minimal supervision in a work from home environment
  
  

Qualifications:

• Bachelor's degree in Nursing or Master Social Work / Counseling required
• 1+ year(s) of experience in InterQual preferred
• Strong clinical background with 2-4 years nursing or behavioral health experience required
• 1– 3 years relevant case management / utilization review experience preferred
• Must hold and maintain current licensure in the state in which he or she resides and practices as a mental health professional in accordance with law and regulation, such as a Licensed Professional Counselor (LPC), Licensed Mental Health Counselor (LMHC), Licensed Clinical Social Worker (LCSW), or Licensed Master Social Worker (LMSW).
• Multi-state nursing licensure for compact states required
  
  

"Bricks and mortar do not make a hospital. People do."- Dr. Thomas Frist, Sr.

HCA Healthcare Co-Founder

If you are looking for an opportunity that provides satisfaction and personal growth, we encourage you to apply for our Behavioral Health Utilization Review Specialist opening. We promptly review all applications. Highly qualified candidates will be contacted for interviews. Unlock the possibilities and apply today!

We are an equal opportunity employer. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.