RN Psych Utilization Review Full-time
Centra Health

RN Utilization Review II-Behavioral Health-FT/Days

apartment Centra Health location_onLynchburg, VA, US
Apply Now
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

Share this job

Share to FB Share to LinkedIn Share to Twitter

Related Jobs

RN Med-Surg Full-time
Centra Health

Patient Care Technician-BMH Med Surg-PRN/Variable Hours

apartment Centra Health location_onBedford, VA
Job Description The Patient Care Technician functions under the supervision of a licensed professional nurse performing care appropriate to the patient population served and meeting daily routine patient care needs. The Patient Care Technician adheres to a culture reflective of Centra's best practice for quality and service, creates and maintains a safe patient environment, and contributes to a healthy work environment. Responsibilities Assists nursing staff in gathering patient data. Provides and documents patient care under the direction of the professional nurse and as outlined in the plan of care. Communicates patient response to plan of care and changes in patient’s condition to the appropriate staff. Responds to patient requests for assistance promptly. Utilizes proper body mechanics in moving, turning, and transporting patients and materials. Creates an environment that protects patients from harm. Adheres to National Patient Safety goals. Consistently practices Centra Safety behaviors. Applies Unit Service Excellence best practices in approaching patients, visitors, providers, and colleagues. Utilizes resources (time, people, supplies, etc.) cost effectively. Handles conflict resolution opportunities in an appropriate, timely, and consistent manner. Monitoring Vital Signs, along with Intake and Output. Assisting the patient with Activities of daily living (ADL’s) such as toileting, feeding, ambulation, bathing, turning, etc. Collection of laboratory (blood/urine/stool) samples. Changing bed linens. Performing EKG studies. Respond to patient requests for assistance and/or needs. Perform competency-based skill sets for patient care (wound care, foley insertion, etc.) Interpret and respond to patient cardiac rhythms. Obtaining patient weights. Transferring a patient to another floor or for radiology study. Keeping the rooms clean and free of clutter. Assisting with CPR in doing compressions and/or attaining resources needed. Helping to stock supplies in patient rooms. May perform other duties as assigned or requested and job specification can be modified or updated at any time. Qualifications Required Certifications and Licensures: Hold a current, active American Heart Association Basic Life Support (AHA BLS) course completion card. Preferred Education: High School Diploma / GED
RN Med-Surg New Grad Full-time
Centra Health

MAY/AUGUST 2026 RN NEW GRAD ONLY-BMH MED/SURG-FT/7P-7A

apartment Centra Health location_onBedford, VA
Job Description The professional registered nurse (RN) plans, coordinates, and manages the care provided to assigned patients and practices under the tenets of Centra's Professional Practice Model. The RN acts as the leader in collaborating with members of the interdisciplinary team, providing the foundation for creating the interdisciplinary plan of care. Throughout the patient's stay, the RN coordinates the various care processes that are necessary to achieve desired outcomes, and delegates, as appropriate. The RN works to promote and sustain a culture reflective of Centra's best practices for quality and service, creates and maintains a safe patient environment, and contributes to a healthy work environment. The practice of the RN reflects the American Nurses Association's (ANA) Code of Ethics for Nurses, the Nurse Practice Act of Virginia, and the ANA Principles of Nurse Staffing. P&BH: Reports to MANAGER UNIT SCH VBH Responsibilities Practices under the tenets of Centra's Professional Practice Model Plans, coordinates, manages, and documents the care provided to assigned patients Delegates to care providers according to the ANA Principles of Nurse Staffing Thinks critically as evidenced by appropriate clinical decision-making and prioritization Leads, communicates and collaborates with the interdisciplinary team to plan patient care Creates and maintains an environment that protects patients from harm Adheres to National Patient Safety Goals (NPSG) Participates in initiatives resulting from nurse-sensitive quality indicators and/or unit-based quality metrics Ensures appropriate patient and/or caregiver education with utilization of applicable resources Promotes and sustains a culture reflective of Centra's best practices Operationalizes change resulting from evidence-based practice or research Operationalizes unit-based action plans to achieve or exceed service excellence benchmarks Participates in service recovery and uses appropriate resources during complex situations Handles conflict resolution in an appropriate, timely, and consistent manner Identifies personal contributions to unit-based cascading goals Admits, transfers and/or discharges patients safely and efficiently Uses resources (e.g., time, people, supplies, etc.) cost effectively Engages in own professional development as evidenced by self assessment and attainment of degrees, certifications, and continuing education Contributes to providing a supportive environment that is conducive to learning for all students from all academic programs Other duties as assigned Qualifications Required Education: Graduate of an accredited Nursing Program Required Certifications and Licensures: Hold a current, active license as a registered nurse in Virginia or hold a current multistate licensure privilege as a registered nurse. Hold a current, active American Heart Association Basic Life Support (AHA BLS) course completion card.
RN Med-Surg New Grad Full-time
Centra Health

MAY/AUGUST 2026 RN NEW GRAD ONLY-BMH MED/SURG-FT/7A-7P

apartment Centra Health location_onBedford, VA
Job Description The professional registered nurse (RN) plans, coordinates, and manages the care provided to assigned patients and practices under the tenets of Centra's Professional Practice Model. The RN acts as the leader in collaborating with members of the interdisciplinary team, providing the foundation for creating the interdisciplinary plan of care. Throughout the patient's stay, the RN coordinates the various care processes that are necessary to achieve desired outcomes, and delegates, as appropriate. The RN works to promote and sustain a culture reflective of Centra's best practices for quality and service, creates and maintains a safe patient environment, and contributes to a healthy work environment. The practice of the RN reflects the American Nurses Association's (ANA) Code of Ethics for Nurses, the Nurse Practice Act of Virginia, and the ANA Principles of Nurse Staffing. P&BH: Reports to MANAGER UNIT SCH VBH Responsibilities Practices under the tenets of Centra's Professional Practice Model Plans, coordinates, manages, and documents the care provided to assigned patients Delegates to care providers according to the ANA Principles of Nurse Staffing Thinks critically as evidenced by appropriate clinical decision-making and prioritization Leads, communicates and collaborates with the interdisciplinary team to plan patient care Creates and maintains an environment that protects patients from harm Adheres to National Patient Safety Goals (NPSG) Participates in initiatives resulting from nurse-sensitive quality indicators and/or unit-based quality metrics Ensures appropriate patient and/or caregiver education with utilization of applicable resources Promotes and sustains a culture reflective of Centra's best practices Operationalizes change resulting from evidence-based practice or research Operationalizes unit-based action plans to achieve or exceed service excellence benchmarks Participates in service recovery and uses appropriate resources during complex situations Handles conflict resolution in an appropriate, timely, and consistent manner Identifies personal contributions to unit-based cascading goals Admits, transfers and/or discharges patients safely and efficiently Uses resources (e.g., time, people, supplies, etc.) cost effectively Engages in own professional development as evidenced by self assessment and attainment of degrees, certifications, and continuing education Contributes to providing a supportive environment that is conducive to learning for all students from all academic programs Other duties as assigned Qualifications Required Education: Graduate of an accredited Nursing Program Required Certifications and Licensures: Hold a current, active license as a registered nurse in Virginia or hold a current multistate licensure privilege as a registered nurse. Hold a current, active American Heart Association Basic Life Support (AHA BLS) course completion card.
RN ICU New Grad Full-time
Centra Health

MAY/AUGUST RN NEW GRAD ONLY - Specialty A-BMH ICU-FT/7A-7P

apartment Centra Health location_onBedford, VA
Job Description The professional registered nurse (RN) plans, coordinates, and manages the care provided to assigned patients and practices under the tenets of Centra's Professional Practice Model. The RN acts as the leader in collaborating with members of the interdisciplinary team, providing the foundation for creating the interdisciplinary plan of care. Throughout the patient's stay, the RN coordinates the various care processes that are necessary to achieve desired outcomes, and delegates, as appropriate. The RN works to promote and sustain a culture reflective of Centra's best practices for quality and service, creates and maintains a safe patient environment, and contributes to a healthy work environment. The practice of the RN reflects the American Nurses Association's (ANA) Code of Ethics for Nurses, the Nurse Practice Act of Virginia, and the ANA Principles of Nurse Staffing. P&BH: Reports to MANAGER UNIT SCH VBH Qualifications Required Education: Graduate of an accredited Nursing Program Required Experience: One (1) year of external nursing experience or completion of Nurse Residency Program (NRP) for new nurses with less than six (6) months of experience Required Certifications and Licensures: Hold a current, active license as a registered nurse in Virginia or hold a current multistate licensure privilege as a registered nurse. Hold a current, active American Heart Association Basic Life Support (AHA BLS) course completion card.
RN New Grad Full-time
Centra Health

MAY/AUGUST 2026 RN NEW GRAD ONLY-BMH-ED-FT/7P-7A

apartment Centra Health location_onBedford, VA
Job Description The professional registered nurse (RN) plans, coordinates, and manages the care provided to assigned patients and practices under the tenets of Centra's Professional Practice Model. The RN acts as the leader in collaborating with members of the interdisciplinary team, providing the foundation for creating the interdisciplinary plan of care. Throughout the patient's stay, the RN coordinates the various care processes that are necessary to achieve desired outcomes, and delegates, as appropriate. The RN works to promote and sustain a culture reflective of Centra's best practices for quality and service, creates and maintains a safe patient environment, and contributes to a healthy work environment. The practice of the RN reflects the American Nurses Association's (ANA) Code of Ethics for Nurses, the Nurse Practice Act of Virginia, and the ANA Principles of Nurse Staffing. P&BH: Reports to MANAGER UNIT SCH VBH Qualifications Required Education: Graduate of an accredited Nursing Program Required Experience: One (1) year of external nursing experience or completion of Nurse Residency Program (NRP) for new nurses with less than six (6) months of experience Required Certifications and Licensures: Hold a current, active license as a registered nurse in Virginia or hold a current multistate licensure privilege as a registered nurse. Hold a current, active American Heart Association Basic Life Support (AHA BLS) course completion card.