Behavioral Health Utilization Review Jobs in Madison, WI

Shifts Available:

Nights: 10:00p - 8:30a

4/10s with weekend rotation

Sign on $7500

Are you prepared for the impact you can make as an RN in Behavioral Health? We are looking for Registered Nurses at Shorewood Behavioral Health. 

This BRAND NEW state-of-the-art 120-bed behavioral healthcare hospital is located in Madison, WI.  Shorewood Behavioral Health Hospital will specialize in providing comprehensive acute and outpatient psychiatric care for adolescents, adults, and seniors dealing with mental health and substance use disorders. The hospital will offer Partial Hospitalization Programs (PHP), Intensive Outpatient Programs (IOP), and Electroconvulsive Therapy (ECT), along with the development of specialized programs to meet community need. 

PURPOSE STATEMENT:

Clinical professional is responsible for facilitating admissions, clinical intake assessments, and utilization review processes to assure continuity for the most appropriate level of care for patients and their benefit/resource utilization.

• Review medical documentation for all admissions, complete medication reconciliation, and obtain admission orders from physicians.
• Facilitate emergency transfers for patients presenting with emergency medical conditions outside of the facility's capabilities.
• Review referrals from hospitals, facilities, and other community agencies for medical and behavioral acuity and respond within facility policy timeframes.
• Respond to inquiries about the facility and provide appropriate recommendations.
• Conduct assessments to determine the appropriate level of care within the facility.
• Collaborate with other facility medical and psychiatric personnel to ensure appropriate recommendations and admissions.
• Facilitate admissions process for incoming patients including assessment, consent, and inventory of patient belongings.
• Perform insurance benefit verifications and secure initial pre-authorization for treatment and admission.
• Monitor patient status throughout the admissions process in accordance with facility policy and/or physician orders.
• Utilize multiple web-based programs to track and review referrals.
• Communicate projected admissions to designated internal representatives promptly.
• Ensure all clinical information from referral sources or patients (including medical comorbidity information) is received, when possible, prior to patient admission.
• Schedule (when applicable) and complete pre-admission assessments, consult with the admitting physician and communicate disposition recommendations to the patient or their family.
• Possess skill in preparing and maintaining appropriate medical record documentation that will result in authorization at the level of care being requested of the payor.
• Complete initial pre-authorization for treatment and admission prior to admission, when possible, and within payor timeframe guidelines.
• Admit the patient to the registration and accounting system. Complete all admission and consent forms with the patient.
• Demonstrate a positive, empathetic, and professional attitude toward customers always. When patient needs are not met, acknowledge and work to resolve complaints. Recognize that patient safety is a top priority.
• When a patient's needs are not met, acknowledge and work to resolve complaints. Recognize that patient safety is a top priority.
• Coordinate care for patients who are not being admitted and ensure that they receive appropriate follow-up care and referrals.
• Demonstrate a sense of urgency related to the importance of patient safety and provide excellent customer service.
• Responsible for conducting safety checks and ensuring that supervision is conducted at 15-minute intervals, as noted in special precautions, or in accordance with individualized supervision guidelines as needed.

OTHER FUNCTIONS:

• Perform other functions and tasks as assigned.

EDUCATION/EXPERIENCE/SKILL REQUIREMENTS: 

• Minimum of Associate's degree in Nursing.  
• Minimum one year of experience working with individuals in a clinical or observational capacity, preferably within the area of specialty for the hiring facility. 

LICENSES/DESIGNATIONS/CERTIFICATIONS: 

• Clear and active nursing license in the state. 
• CPR and de-escalation/restraint certification required (training available upon hire and offered by facility). 
• First aid may be required based on state or facility 

We are committed to providing equal  employment opportunities to all applicants for employment regardless of an individual's characteristics protected by applicable state, federal and local laws.

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