Registered Nurse (RN) - Utilization Review Behavioral Care, PRN, Day

Job description

Inspire health. Serve with compassion. Be the difference. Job Summary: Performs systematic review of patient charts in order to assess medial necessity and relay information to managed care, review and insurance companies (third party payers). Works collaboratively with the physician and treatment team to secures authorization of payment for patients' services. Documents and provides communication to treatment team (including physician), Business Office and Patient Accounts. Serves as liaison in coordination of pre-certification and concurrent review requirements. Coordinates the preparation of appeal efforts in cases of third party denials. Essential Functions: All team members are expected to be knowledgeable and compliant with Prisma Health's values: Inspire health. Serve with compassion. Be the difference. Performs review of patient medical record and documents patient symptoms, progress, mental status, treatment plan, changes and pertinent information needed for communication with third party payers. Utilizes critical thinking skills to analyze patient progress and records to determine legitimacy of admission, treatment, and length of stay to comply with governmental and insur...