Utilization Review Nurse or Specialist

6 days ago

Brooklyn Park, United States PrairieCare Full time

About Us

We are a psychiatric healthcare system, dedicated to providing mental healthcare for all, with seven locations in the Minneapolis/St. Paul metro area, and two additional sites located in Rochester and Mankato. With a robust benefits package, career advancement opportunities, and great workplace culture, we value our employees and the work they do each day for our patients and families. Our services span the full continuum of care for patients, with a variety of roles and opportunities for job-seekers looking for more than a job, but a place where you can grow in your career.

Responsibilities

This role is primarily remote, occasional work required onsite at our Brooklyn Park location

Hours are Monday - Friday between 8a-5p

Acts as a liaison between the clinical treatment team and third-party payers to promote appropriate treatment for psychiatric illness and any other prescribed needs

Responsibilities and Accountabilities:

  • Obtain initial behavioral health authorization and complete concurrent reviews
  • Review the need for denial of stay with assigned clinical treatment team when patient no longer meets acute care criteria
  • Facilitates appropriate action upon denial
  • Maintains current level of knowledge on contract requirements of all third-party payor groups
  • Tracks each patient's course of treatment through inpatient, partial hospitalization programs and IOP programs
  • Oriented and educated in gender, cultural differences and in age appropriate care for Utilization Review
Qualifications
  • Requires knowledge of nursing practices, which can be gained only through an accredited school of nursing. Current licensure with the Minnesota State Board of Nurse Examiners is required.
  • Required to be knowledgeable of and follow the Nurse Practice Act
  • Previous utilization review experience preferred
  • Knowledge of UR Standards of Excellence
  • Display a professional attitude in all aspects of nursing performance
  • Must be proficient in using Microsoft Office Products including Word and Outlook.

Driven by our values and commitment to safety and quality care, PrairieCare will be joining every major health system in Minnesota with our plans to require a COVID-19 vaccine for all team members, or an approved exemption limited to medical or religious accommodations.

PrairieCare is a psychiatric healthcare system experiencing rapid growth in the Twin Cities and southern Minnesota. With multiple sites across the metro, including locations in Rochester and Mankato, PrairieCare has quickly grown to become one of Minnesota's largest providers of mental health services to children, adolescents, adults, and their families.

PrairieCare does not discriminate against any person based on race, color, national origin, disability, or age in admissions, treatment, or participation in its programs, services, activities, or employment. PrairieCare is an Affirmative Action Employer/Equal Opportunity Employer supporting Veterans, Disabled, and other protected individuals and is committed to a diverse workforce. Offers of employment from PrairieCare are conditional and contingent upon successful clearance of all background studies.

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