AllentownRecruiter Since 2001
the smart solution for Allentown jobs

Utilization Review Registered Nurse, Behavioral Health

Company: St. Luke's University Health Network
Location: Allentown
Posted on: January 12, 2021

Job Description:

St. Luke's is proud of the skills, experience and compassion of its employees. The employees of St. Luke's are our most valuable asset! Individually and together, our employees are dedicated to satisfying the mission of our organization which is an unwavering commitment to excellence as we care for the sick and injured; educate physicians, nurses and other health care providers; and improve access to care in the communities we serve, regardless of a patient's ability to pay for health care.The Utilization Review Nurse will be responsible for substantiating medical necessity and clinical appropriateness of services in order to achieve quality outcomes and ensure appropriate reimbursement. JOB DUTIES AND RESPONSIBILITIES:* Screens selected medical records in accordance with contractual agreements and departmental policies for appropriateness of admission; performing initial, continued stay, and retrospective reviews if applicable.* Submits initial reviews and updates using established criteria and communicates with payers as appropriate, using established processes.* Utilize established processes to manage second level and peer to peer reviews.* Ensure patient status and levels of care are appropriate on admission and prior to discharge.* Makes timely contact with payers and provides information as appropriate.* Documents all utilization review outcomes and activities appropriately in the medical record.* Complies with all applicable payer, state and federal regulations as well as The Joint Commission requirements regarding Care Management and Utilization Review processes.* Acts as resource for and provides updates to the care management staff and care team for issues related to utilization review processes.* Engages providers with concerns regarding medical necessity and appropriateness of services.* Escalate concerns related to medical necessity and appropriateness of services.* appeals and documents according to established policy.* Works collaboratively with the business office/finance to ensure proper reimbursement.PHYSICAL AND SENSORY REQUIREMENTS: Sitting for one to two hours at a time. Standing for up to 2 hours per day, up to 10 minutes at a time. Walk on all surfaces for up to 3 hours per day, and climb stairs. Must be capable of driving a car. Fingering and handling objects frequently, uses fingers to turn pages. Frequently uses hands to write and/or type. Rarely uses hands or fingers for firm grasping or twisting/turning. Frequently uses upper extremities to lift and carry object up to 10 lbs. Rarely may be required to lift, carry, push, and/or pull objects weighing up to 75 pounds. Occasionally stoops, bends, squats, kneels and reaches above shoulder level. Must have the ability to hear as it relates to normal conversations and high and low frequencies and to see as it relates to general and peripheral vision. Must have the ability to touch as related to telephone and computer keyboard.EDUCATION: Graduate of professional nursing program. Registered Nurse with current license to practice in the State of Pennsylvania or seeking Pennsylvania licensure through reciprocity. Advanced degree preferred. TRAINING AND EXPERIENCE: At least 3 years of clinical experience as a registered nurse in an acute setting; Behavioral Health preferred. Either 2 years of hospital or payor based utilization review experience preferred. Knowledge of Interqual and Milliman criteria preferred. Care Management certification preferred.WORK SCHEDULE: Monday thru Friday, primarily days. Flexibility may be required to meet unit needs.Please complete your application using your full legal name and--current home address. Be sure to--include--employment history for--the past seven (7) years, including your present employer. Additionally, you are--encouraged to upload a current resume, including all work history, education, and/or certifications and--licenses, if applicable. It is highly recommended that you create a profile at the conclusion of submitting your first application. Thank you for your interest in St. Luke's!!St. Luke's University Health Network is an Equal Opportunity Employer.

Keywords: St. Luke's University Health Network, Allentown , Utilization Review Registered Nurse, Behavioral Health, Other , Allentown, Pennsylvania

Click here to apply!

Didn't find what you're looking for? Search again!

I'm looking for
in category
within


Other Other Jobs


FedEx Operations - Packaging
Description: Auto req ID: 262620BR br Job Summary FedEx Ground is an essential business that needs people to help us support the economy, handling life-saving medications and other items that keep our communities (more...)
Company: FedEx Ground PH US
Location: Harrisburg
Posted on: 01/17/2021

Need a gig? Deliver with Uber Eats!
Description: Deliver with Uber. Earn on your schedule.Deliver with Uber Eats on your schedule. Deliver for a few hours in the mornings, every night, or just on weekends-it's up to you.Earn Extra Money. You'll earn (more...)
Company: Uber Eats
Location: Harrisburg
Posted on: 01/17/2021

Part-Time Delivery
Description: Deliver with Uber. Earn on your schedule.Work on your schedule. Deliver for a few hours in the mornings, every night, or just on weekends-it's up to you.Earn Good Money. You'll earn by bringing people
Company: Uber Eats
Location: Harrisburg
Posted on: 01/17/2021


Quartermaster and Chemical Equipment Repairer (91J)
Description: The Army National Guard uses a wide range of systems that help protect and serve the force, and as a Quartermaster and Chemical Equipment Repairer, you'll be in charge of making sure those systems keep (more...)
Company: Army National Guard
Location: Harrisburg
Posted on: 01/17/2021

Chiropractor
Description: Chiropractor Quarryville, PA 17566 Seeking a motivated chiropractor to provide top-notch chiropractic care to patients. You must enjoy working with infants,
Company: Healthcare Recruitment Counselors
Location: Lancaster
Posted on: 01/17/2021

CRIMINAL JUSTICE CAREER TRAINING - LOCAL CRIMINAL JUSTICE TRAINING AVAILABLE
Description: Interested in a career in the Criminal Justice field My Justice Career can help START TRAINING FOR YOUR NEW CRIMINAL JUSTICE CAREER TODAY Graduate employment services may be available once training (more...)
Company: My Justice Career
Location: Lancaster
Posted on: 01/17/2021

25Q Multi-Channel Transmission Systems Operator-Maintainer
Description: For the military to make strategic decisions, they depend on having the right information when they need it. Multi-Channel Transmission Systems Operator-Maintainers ensure the communication to make these (more...)
Company: Army National Guard
Location: Harrisburg
Posted on: 01/17/2021

Make up to $19/hour - Deliver with DoorDash
Description: Your time. Your Goals.What is DoorDashAvailable in over 4,000 cities in the U.S., Canada, and Australia, DoorDash is about connecting people with possibilities: bigger savings accounts, wider nets, stronger (more...)
Company: Doordash
Location: Harrisburg
Posted on: 01/17/2021

Senior Systems Integration, Verification and Validation
Description: Systems Integration, Verification and Validation IV V Engineer The Systems Engineering Center SEC Department within the Raytheon Intelligence and Space RIS Business Segment is involved in a wide (more...)
Company: RTX
Location: Lancaster
Posted on: 01/17/2021

District Operations Specialist - S New Jersey/SE Pennsylvania
Description: SUMMARY MSX International is seeking an Operations Specialist who will be responsible for the professional delivery, installation and sustainment of MSX International Retail Automotive Service prescribed (more...)
Company: MSX International
Location: Harrisburg
Posted on: 01/17/2021

Log In or Create An Account

Get the latest Pennsylvania jobs by following @recnetPA on Twitter!

Allentown RSS job feeds