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Coordinates utilization review activities for the purpose of monitoring standards of patient care and to take action to improve care and maintain quality care. Work is performed in accordance with established professional policy, procedures, practices, regulatory requirements and accrediting body standards. Provides professional nursing care to clients in the ACT Program. Directs and supervises activities and assignments of ancillary personnel to the ACT Program. Is responsible for providing a broad range of treatment and rehabilitation activities.

MINIMUM QUALIFICATIONS: EDUCATION, CERTIFICATION, AND/OR LICENSURE: 1. Licensure in the state of WV to practice as a Registered Nurse. 2. Obtain certification in Basic Life Support within 30 days of hire date. 3. West Virginia state criminal background check, and federal, if applicable, required for DHHR regulated area. EXPERIENCE: 1. Two (2) years clinical experience in mental health field.

PREFERRED QUALIFICATIONS: EXPERIENCE: 1. One (1) year utilization review experience.

CORE DUTIES AND RESPONSIBILITIES:The statements described here are intended to describe the general nature of work being performed by people assigned to this position. They are not intended to be constructed as an all-inclusive list of all responsibilities and duties. Other duties may be assigned.

1. Conducts initial clinical assessment of the patient at the time of admission to determine medical necessity using established admission criteria.
2. Performs concurrent and retrospective reviews with all third party payers consistent with their time frames and individual criteria.
3. Coordinates all aspects of the certification process to ensure that proper reimbursement is attainable. This includes pre-certifications, continued stay reviews, appeals, and any associated paperwork.
4. Facilitates ongoing education of house staff regarding proper documentation techniques.
5. Is the ACT Program's advocate in a liaison relationship with third party payers and regulatory agencies.
6. Assures that all aspects of the medical record meet established hospital and accrediting agency standards.
7. Consistently protects the confidentiality of all clinical data relating to patients, physicians, and personnel.
8. Coordinates all quality assurance activities relevant to patient care, treatment planning and program evaluation.
9. Responsible for continued professional development in current utilization review standards and practices.
10. Collects and records data that is comprehensive, accurate and systematic, on the nursing and psychosocial assessment forms and... For full info follow application link.

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities. Please view Equal Employment Opportunity Posters provided by OFCCP here. 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)