Summary

The Behavioral Utilization Nurse performs the initial precertification for all inpatient stays as well as all concurrent reviews for continued stay. UR Nurse completes MCG criteria for all Medicare stays. UR Nurse also completes initial authorization requests and follow up reviews for the hospital based outpatient programs. The job requires an understanding of the various levels of care and criterion for each. The UR nurse must understand the clinicals being presented and have excellent communication and organizational skills. Other tasks include scheduling peer to peer reviews, insurance verification, submitting avoidable days, inputting MCG criteria, and documenting authorization information within EPIC.

Job Description:

The Behavioral Utilization Nurse performs the initial precertification for all inpatient stays as well as all concurrent reviews for continued stay.  UR Nurse completes MCG criteria for all Medicare stays.  UR Nurse also completes initial authorization requests and follow up reviews for the hospital based outpatient programs. The job requires an understanding of the various levels of care and criterion for each.  The UR nurse must understand the clinicals being presented and have excellent communication and organizational skills. Other tasks include scheduling peer to peer reviews, insurance verification, submitting avoidable days, inputting MCG criteria, and documenting authorization information within EPIC.

Work Experience

Education

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Baptist Health is an Equal Employment Opportunity employer.