UR Specialist-PRN- RN or LPN

Proactively monitor utilization of services for patients to optimize reimbursement for the facility. Provide assistance to patients and their families by developing a documented continuing care plan to ensure ongoing support in recovery and or other behavioral, mental or health care follow up after discharge from the facility. Red River Hospital is the leading provider of inpatient and outpatient behavioral healthcare in Wichita Falls, TX. Our treatment services & specialized programs address drug and alcohol addiction and co-occurring mental illness. Red River Hospital has been a leader in behavioral healthcare for over 40 years, providing superior healthcare treatment to the people, communities, and military installations we serve. We are a private inpatient 96 bed acute psychiatric facility dedicated to the treatment of behavioral health and substance abuse services. Located in Wichita Falls, Texas, Red River Hospital provides mental health and substance abuse treatment to the following populations: • Dedicated military personnel • Adults • Seniors • Children and adolescents (ages 5 through 17) Our excellent staff is committed to the continuous improvement of behavioral healthcare by providing treatment opportunities that promote individual, family, and community wellness. As a team, we are dedicated to providing high quality, outstanding care and attending to the individual needs of each patient and their family in a caring and compassionate manner. Serving Northern Texas and Southern Oklahoma Our location in Wichita Falls allows for convenient access to residents of nearby Texas cities like Burkburnett as well as South Oklahoma cities like Lawton. Call the number below to begin the process of healing. Mission, Vision & Values Mission: To bring light into the lives of our patients and their families, to inspire hope through supportive, individualized care, and to serve our community by setting the standard for excellence in the treatment of mental health and addiction concerns Vision: To be the behavioral healthcare provider and employer of choice. Values: RESPECT EMPATHY DEDICATION POSTION DETAILS: This position is a relief position in our Utilization Review Department, which will include covering for our UR Specialists and Discharge Planner. This is a per diem position with no guaranteed hours. Utilization Review Specialist ESSENTIAL FUNCTIONS: • Act as liaison between managed care organizations and the facility professional clinical staff. • Conduct reviews, in accordance with certification requirements, of insurance plans or other managed care organizations (MCOs) and coordinate the flow of communication concerning reimbursement requirements. • Monitor patient length of stay and extensions and inform clinical and medical staff on issues that may impact length of stay. • Gather and develop statistical and narrative information to report on utilization, non-certified days (including identified causes and appeal information), discharges and quality of services, as required by the facility leadership or corporate office. • Conduct quality reviews for medical necessity and services provided. • Facilitate peer review calls between facility and external organizations. • Initiate and complete the formal appeal process for denied admissions or continued stay. • Assist the admissions department with pre-certifications of care. • Provide ongoing support and training for staff on documentation or charting requirements, continued stay criteria and medical necessity updates. Discharge Planner ESSENTIAL FUNCTIONS: • Develop continuing after care plan, based on patient's needs, to promote long term health and relapse prevention. • Responsible for setting discharge appointments for patients, including group or individual therapy, psychologist or psychiatrist. • Make arrangements for community resources to facilitate discharge. Provide all needed documentation to other providers to facilitate the continuum of care. • Act as a liaison between referral sources, patients and counselors. • Ensure all patient discharge planning documentation is clear, concise and timely. OTHER FUNCTIONS: • Perform other functions and tasks as assigned. EDUCATION/EXPERIENCE/SKILL REQUIREMENTS: • Associate's degree in nursing (LPN or RN) required; Bachelor's Degree Preferred. Bachelor's or Master’s degree in social work, behavioral or mental health, nursing or other related health field preferred. • One or more years’ experience in a clinical setting preferred. • One or more years’ experience in discharge planning preferred. • Two or more years' experience with the population of the facility and previous experience in utilization management preferred. LICENSES/DESIGNATIONS/CERTIFICATIONS: • Current licensure as an LPN or RN within the state where the facility provides services; or current clinical professional license or certification, as required, within the state where the facility provides services. • CPR and de-escalation and restraint certification required (training available upon hire and offered by facility. • First aid may be required based on state or facility requirements. Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information. 41 CFR 60-1.35(c) Apply Job!