RN Admissions Coordinator/Utilization Review - Psychiatric Unit

apartment PeaceHealth location_onEugene, OR, US

$47 - $71 / HOUR

Description

Job Description

PeaceHealth is seeking a RN Admissions Coordinator/Utilization Review - Psychiatric Unit for a Per Diem/Relief, 0.00 FTE, Variable position. The salary range for this job opening at PeaceHealth is $47.34 – $71.00. The hiring rate is dependent upon several factors, including but not limited to education, training, work experience, terms of any applicable collective bargaining agreement, seniority, etc.

Responsible for identifying potential behavioral health inpatient unit candidates, pre-screening referrals, and preparing patients for admission to Behavioral Health Inpatient Unit, including patient consultation.

Essential Functions

Coordinates admissions; communicates and prioritizes, and provides for patient privacy; exercises discretion and assures confidentiality at all times.
Assesses patient referrals to determine that patient meets all admission criteria.
Collaborates with physicians, referral sources, and other staff to monitor issues and status; establishes timing of admissions.
Coordinates the admission process with patients, families, referring facilities, physicians, emergency departments’ crisis workers, public safety officers, outside agencies and Behavioral Health Inpatient Unit staff.
Provides documentation of medical necessity and obtains authorization for treatment regarding acute inpatient psychiatric benefits.
Identifies patients in need of financial assistance and refers to the appropriate programs.
Performs data collection and statistical compilation and analysis of data bases relative to quality assurance and effectiveness of programs.
Provides professional psychiatric nursing presence and oversight based on unit needs.
Performs other duties as assigned.

What you bring:

Accredited School of Nursing Required
Bachelor's Degree Preferred: Mental Health
Bachelor's Degree Preferred: Health Services
Bachelor's Degree Preferred: Nursing or
Bachelor's Degree: Health Sciences
Required: Must have strong psychiatric nursing background and previous admission coordination experience
Required: Registered Nurse in state of practice
Preferred: Psychiatric Mental Health Nursing

Department / Location Specific Notes

Oregon: Assumes job functions of a Transfer Coordinator as needed. CareConnect access.

PeaceHealth is committed to the overall wellbeing of our caregivers. The benefits included in positions less than 0.5 FTE are 403b retirement plan for caregiver contributions; wellness benefits, discount program, and expanded EAP and mental health program.

See how PeaceHealth is committed to

For full consideration of your skills and abilities, please attach a current resume with your application. EEO Affirmative Action Employer/Vets/Disabled in accordance with applicable local, state or federal laws.

Share this job

Related Jobs

Full-time

RN - Emergency Department

apartment PeaceHealth location_onCottage Grove, OR

$49.64 - $74.46 / HOUR

Description Job Description PeaceHealth is seeking a RN - Emergency Department for a Part Time, 0.60 FTE, Night position. The salary range for this job opening at PeaceHealth is $49.64 – $74.46. The hiring rate is dependent upon several factors, including but not limited to education, training, work experience, terms of any applicable collective bargaining agreement, seniority, etc. *** Hiring Bonus & Relocation Assistance may be available! *** Spotlight on Cottage Grove Community Medical Center: Provides professional nursing direct patient care in compliance with professional practice and unit standards. Promotes a collaborative, interdisciplinary approach towards patients, families and all members of the care delivery team. Details of the position: Assess, plan, implement and evaluate patient care needs. Documents patient care in the healthcare record according to established standards. Directs and delegates care to other team members in accordance with their education, credentials, and demonstrated competence. Ensures own professional effectiveness through education and professional development. Participates in the development of and maintains established hospital policies, procedures and objectives, quality improvement, safety, environmental and infection prevention program. Performs other duties as assigned. What you bring: Accredited School of Nursing Required: Nursing Bachelor's Degree Preferred: Bachelor of Science in Nursing Preferred: Specialty certification 1 year Preferred: Experience as a registered nurse Preferred: of recent ED experience (within the past 5 years). Preferred: ED experience in like sized and like-census ED Preferred: Experience at a Magnet or Academic hospital Preferred: Experience with a shared governance model Preferred: Hospital accredited and certified by DNV or TJC Required: Registered Nurse Required Upon Hire: Basic Life Support Required: ACLS and PALS must be obtained within a standard grace period from hire or transfer, as specified in the Resuscitation Training Completion Requirements policy. PeaceHealth is committed to the overall wellbeing of our caregivers: physical, emotional, financial, social, and spiritual. We offer caregivers a competitive and comprehensive total rewards package. Some of the many benefits included in this package are full medical/dental/vision coverage; 403b retirement plan employer base and matching contributions; paid time off; employer-paid life and disability insurance with additional buyup coverage options; tuition and continuing education reimbursement; wellness benefits, and expanded EAP and mental health program. See how PeaceHealth is committed to For full consideration of your skills and abilities, please attach a current resume with your application. EEO Affirmative Action Employer/Vets/Disabled in accordance with applicable local, state or federal laws. Show more Show less

Psych

Utilization Review

Full-time

RN Utilization Review II-Behavioral Health-FT/Days

apartment Centra Health location_onLynchburg, VA

Job Description Utilization review nurse is responsible for the day to day coordination of admission criteria as it relates to healthcare needs of the patient and organization. Including knowledge of regulatory and compliance with Medicare, Medicaid and other insurance payors. This team member will communicate with a variety of clinical discipline, commercial payers, patient access, patient financial services, physician advisor and other staff members. Responsibilities Provides, initial, concurrent and retrospective reviews if assigned patients for severity of illness and intensity of service Demonstrates the ability to interpret InterQual and Milliman and Roberts criteria to ensure the patients meet admission and continued stay criteria Provides accurate and complete account authorization and details in plan notes Performs admission review on the following business day of patient's admission Involves the Physician Advisor as needed when physician-to-physician interaction is required to achieve appropriate clinical utilization for the patient Collaboratively works with the Physician Advisor to facilitate all aspects of the utilization management plan Serve as a liaison to patient accounting, patients access as it relates to authorizations and claims Demonstrates ability to communicate effectively with internal and external customers Demonstrates commitment toward customer satisfaction and patient advocacy Maintains confidentiality of patient/physician/and other team members as well as maintaining compliance with all federal/state guidelines and regulations Achieves budget length of stay (LOS) goal May perform other duties as assigned or requested and job specification can be modified or updated at any time Qualifications Required Education: Graduate of an accredited Nursing Program Preferred Education: Bachelors of Science Degree in Nursing (BSN) Required Experience: Three (3) years of experience in acute care nursing. Computers skills a must as well as excellent communication and the ability to work collaboratively with other disciplines Required Certifications and Licensures: Hold a current, active license as a registered nurse in Virginia or hold a current multistate/compact license. Hold a current, active American Heart Association Basic Life Support (AHA BLS) course completion card. Preferred Certifications and Licensures: ACMA Certification

Psych

Utilization Review

Full-time

Behavioral Health Utilization Management Clinician - Registered Nurse or Behavioral Health Clinician

apartment CVS Health location_onTX

$60,522 - $129,615 / YEAR

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary Utilizes clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program. Applies critical thinking and is knowledgeable in clinically appropriate treatment, evidence based care and clinical practice guidelines for Behavioral Health and/or medical conditions based upon program focus. Concurrent Medical Reviews for Commercial Plans. Collaborating with facilities and providers to document and review for extended stay request. Required Qualifications Licensed Registered Nurse (Compact RN a Plus) with 3 or more years of Behavioral Health Clinical Experience. Independently licensed behavioral health clinician in state of residence. 3+ years post degree experience in a psychiatric or substance abuse setting required 3 years of direct clinical practice experience post masters degree, e.g., hospital setting or alternative care setting such as ambulatory care or outpatient clinic/facility. Preferred Qualifications 3 years Managed care/utilization review experience preferred. Crisis intervention skills and experience preferred Proficiency with computer and technology skills which includes navigating multiple systems and keyboarding. California license or ability to obtain California license preferred Education : Master's degree in Behavioral/Mental health or Human Service/Health Services Associates degree with a Registered Nurse Anticipated Weekly Hours 40 Time Type Full time Pay Range The typical pay range for this role is: $60,522.00 - $129,615.00 This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Great benefits for great people We take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include: Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan . No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching. Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility. For more information, visit https://jobs.cvshealth.com/us/en/benefits We anticipate the application window for this opening will close on: 02/28/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

RN Utilization Manager - Medicine, Oncology, Cardiac, & Psychiatry Services

apartment UNC Health location_onChapel Hill, NC

Description Areas of focus include Medicine, Oncology, Cardiac, and Psychiatry Services Preferences given to candidates with Medical Surgical and/or Psychiatry bedside experience. The Team: Completes clinical reviews for all areas: Inpatient, Observation, Extended Recovery Ensures compliance in accordance to government's federal rules and regulations related to patient care and reimbursement Interacts with the Interdisciplinary Team for patient care progression Protects hospital revenue by working with payors for insurance authorizations, denials, and appeals Delivers mandated federal notices to patients/ patient representatives related to their payer source 40 hrs/week (Monday-Friday) Weekend rotation Holiday rotation No Nights No on-call Become part of an inclusive organization with over 40,000 teammates, whose mission is to improve the health and well-being of the unique communities we serve. Summary: Works in collaboration with the patient/family, and interdisciplinary team (including physicians, other care providers, and payors), and assesses the patient care progression from acute care episode through post discharge for quality, efficiency, and effectiveness. The Utilization Manager works collaboratively with other Clinical Care Management staff to ensure patient needs are met and care delivery is coordinated across the continuum. The Utilization Manager completes admission, continued stay, and discharge reviews in accordance with federal regulations & the Hospitals? Utilization Management Plan. In addition, the Utilization Manager is responsible for revenue protection by reconciling physician orders, bed billing type, and medical necessity. This may include delivering notifications to patients directly. Interface is completed verbally, via email, data base tasks, or other electronic communication and via telephone. Responsibilities: 1. Clinical Review Process - Uses approved criteria and conducts admission review/status change review within 24 hours of patient admission to the hospital to ensure appropriateness of the setting and timely implementation of the plan of care. Identifies and obtains observation status as appropriate. Partners with physicians, nursing, and other care providers to help ensure timely and accurate documentation of patient data and treatments. Communicates daily with the Case Manager to manage level of care transitions & appropriate utilization of services. Coordinates with the support center to assure third party payor pre-certification and/or re-certifications when required. Utilizes high risk screening criteria to make appropriate referrals to Manager. 2. Discharge Facilitation - Identifies patient/families with the complex psychosocial, on-going medical discharge planning issues, continuing care needs by initiating appropriate case management referrals. Initiates appropriate social work referrals. 3. Utilization Management Process - Performs utilization management assessments and interventions, using collaboration with interdisciplinary team approach, on assigned patients as appropriate to ensure optimal patient outcomes. Using approved criteria, conducts continued stay and quality reviews to monitor the patient's progress along the continuum of care and intervenes as necessary to ensure appropriateness of setting and that the services provided are quality-driven, efficient, and effective. Enters all pertinent review data into the correct computer system in a timely manner. Consults with Physician Advisor as necessary to resolve barriers through appropriate administrative and medical channels. 4. Utilization Outcomes Management - Monitors and guides to trend interdisciplinary documentation and guides medical staff in documentation that will assist in coding accuracy, enhance quality of care, reflect accurate severity of illness and appropriate reimbursement. Facilitates patient movement to appropriate (acuity) level of care including observation status issues through collaboration with patient/family, multidisciplinary team, third party payors and resource center. Provides information regarding denials and approvals to designated entities. Assists in coordination of practice parameter development with the assigned departments/sections/specialties of Medical Staff. Oversees collection and analysis of patient care and financial data relevant to the target case types. Directs delivery of notifications to patients (includes traveling to hospital(s) to deliver notifications. Other Information Other information: Education Requirements: ● Graduation from a state-accredited school of professional nursing ● If hired after October 1, 2015, must be enrolled in an accredited program within four years of employment, and obtain a Bachelor's degree with a major in Nursing or a Master's degree with a major in Nursing within seven years of employment date. Licensure/Certification Requirements: ● Licensed to practice as a Registered Nurse in the state of North Carolina. Professional Experience Requirements: ● Two (2) years of clinical experience in a medical facility and/or comparable Utilization Management experience. Knowledge/Skills/and Abilities Requirements: Job Details Legal Employer: STATE Entity: UNC Medical Center Organization Unit: UNCH Care Mgmt-Medical Center Work Type: Full Time Standard Hours Per Week: 40.00 Salary Range: $35.87 - $51.57 per hour (Hiring Range) Pay offers are determined by experience and internal equity Work Assignment Type: Onsite Work Schedule: Day Job Location of Job: US:NC:Chapel Hill Exempt From Overtime: Exempt: Yes This is a State position employed by UNC Health Care System with UNC Health benefits. If, however, you are presently an employee of another North Carolina agency and currently participate in TSERS or the ORP, you will be eligible to continue participating in those plans at UNC Health. Qualified applicants will be considered without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, genetic information, disability, status as a protected veteran or political affiliation. UNC Health makes reasonable accommodations for applicants' and employees' religious practices and beliefs, as well as applicants and employees with disabilities. All interested applicants are invited to apply for career opportunities. Please email applicant.accommodations@unchealth.unc.edu if you need a reasonable accommodation to search and/or to apply for a career opportunity.

Psych

Utilization Review

Full-time

Behavioral Health Utilization Review Clinician

apartment Centene location_onLA

You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility. Position Purpose: Performs a clinical review and assesses care related to mental health and substance abuse. Monitors and determines if level of care and services related to mental health and substance abuse are medically appropriate. Evaluates member’s treatment for mental health and substance abuse before, during, and after services to ensure level of care and services are medically appropriate Performs prior authorization reviews related to mental health and substance abuse to determine medical appropriateness in accordance with regulatory guidelines and criteria Performs concurrent review of behavioral health (BH) inpatient to determine overall health of member, treatment needs, and discharge planning Analyzes BH member data to improve quality and appropriate utilization of services Provides education to providers members and their families regrading BH utilization process Interacts with BH healthcare providers as appropriate to discuss level of care and/or services Engages with medical directors and leadership to improve the quality and efficiency of care Formulates and presents cases in staffing and integrated rounds Performs other duties as assigned. Complies with all policies and standards. Education/Experience: Requires Graduate of an Accredited School Nursing or Bachelor's degree and 2 – 4 years of related experience. License to practice independently, and/or have obtained the state required licensure as outlined by the applicable state required. Master’s degree for behavioral health clinicians required. Clinical knowledge and ability to review and/or assess treatment plans related to mental health and substance abuse preferred. Knowledge of mental health and substance abuse utilization review process preferred. Experience working with providers and healthcare teams to review care services related to mental health and substance abuse preferred. License/Certification: LCSW- License Clinical Social Worker required or LMHC-Licensed Mental Health Counselor required or LPC-Licensed Professional Counselor required or Licensed Marital and Family Therapist (LMFT) required or Licensed Mental Health Professional (LMHP) required or RN - Registered Nurse - State Licensure and/or Compact State Licensure required For Fidelis Care only: LMSW, LCSW, LMHC, LPC, LMFT, LMHP or RN required Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility. Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law. Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act