Utilization Review Nurse; RN- Nights

Bluestone Child & Adolescent Psychiatric Hospital Psychiatric Intake Nurse – FT Nights (5-8 hour shifts – Sunday through Thursday) Nursing – University Heights, OH – Full Time

Psychiatric Intake Nurse – FT Nights, 5-8 hour shifts – Sunday through Thursday

• Comprehensive health and Rx plans, including a flat rate ($5, $10, $15) option.
• Wellness program including free preventative care
• Generous paid time off and holidays
• 50% tuition reduction at Case Western Reserve University for the MSW program
• 403(b) retirement plan with an employer match
• Pet insurance
• Employer paid life insurance and long‑term disability
• Employee Assistance Program
• Support for continuing education and credential renewal
• Ancillary benefits including dental, vision, voluntary life, short‑term disability, hospital indemnity, accident, critical illness
• Flexible Spending Account for Health and Dependent Care

• Education:
  
  Associate’s Degree preferred in Nursing or LPN degree. Bachelor’s or Master’s degree in related field preferred.
• Licensure:
  Valid Ohio RN/LPN license required.
• Skills:
  
  Sensitivity in relating to persons of varying backgrounds and demonstrated ability to work with diverse groups of people possessing various strengths, aptitudes and abilities.
• Ability to perform job responsibilities with a high degree of initiative and independent judgment.
• Demonstrated oral and written communication skills and effective interpersonal skills.
• Proficiency in using agency computer systems and software as required to perform essential job functions. Practical and creative problem‑solving skills.
• Experience:
  
  A minimum of 1 year experience as a psychiatric nurse. 1–2 years experience in behavioral health utilization review preferred.

AGENCY

SUMMARY:

Bluestone is seeking dynamic healthcare professionals interested in bringing psychiatric care to a new level for children ages 6‑17. Working in a brand‑new, 12‑bed state‑of‑the‑art facility, Bluestone staff will have a unique ability to direct patient care, employ best practices, and join a care network that promotes the best long‑term outcomes for patients.

POSITION SUMMARY:

The Psychiatric Intake Nurse independently facilitates clinical reviews, as necessary, on admission and for continued stay care. The Intake Nurse reviews the medical record to ensure medical necessity of admission as well as ongoing inpatient and outpatient treatment. The Intake Nurse also determines the avenues for advocacy on behalf of patients with insurance for utilization of insurance benefits throughout the patient’s treatment.

Further, the Intake Nurse responds to intake inquiries via phone, fax and email. Additionally, Intake Nurse functions as an overnight psychiatric nurse on a routine basis.

• Immediately respond to all Bluestone Intake email, faxes and phone calls.
• Review all referrals for clinical appropriateness within 10 minutes of receipt, except during approved break times.
• Contact the provider on call within 10 minutes of the completed review of the referral.
• Facilitate the admission with the referring hospital, including completing the nurse‑to‑nurse call, creating a new patient admission in the electronic medical record and entering all treatment orders and medications.
• Complete initial, concurrent, and retrospective reviews of patient care in a timely manner to ensure continuous coverage for patients in inpatient treatment.
• Initiate, schedule, and meaningfully participate in peer reviews and expedited appeals between third‑party payers and facilities as needed.
• Maintain sophisticated and current knowledge of mental health disorders including DSM‑V knowledge, ICD‑10 diagnoses and treatment processes.
• Utilize clinical information and knowledge of medical necessity criteria to effectively communicate plans of care to insurance case managers, facility staff, and healthcare partners including the admitting psychiatrist.
• Collaborate with the treatment team to discuss clinical authorization and quality of care.
• Consistent and timely response to emails and other communications relating to utilization review.
• Prepare and submit appeals utilizing their independent knowledge and expertise.
• Familiarity with…