Utilization Review Specialist (or UR Nurse)

Join PrairieCare: Transform Lives Through Meaningful Work! Are you ready to embark on a rewarding career in psychiatric healthcare? At PrairieCare, we are passionate about delivering exceptional mental health services to individuals in need. Our comprehensive approach covers the entire spectrum of care, creating a wealth of diverse roles for those who aspire to make a real impact. We believe in nurturing talent and fostering professional growth in a supportive environment. Here, you won’t just find a job—you’ll discover a fulfilling career path in the mental health field. If you're eager to contribute to a mission-driven organization and help change lives for the better, we invite you to join our dedicated team at PrairieCare. Together, we can make a profound difference in the lives of those we serve!

Are you passionate about making a difference in the lives of those with psychiatric illnesses? Do you thrive in a collaborative environment where your expertise can shine? If so, we have the perfect opportunity for you! What You'll Do: As our Behavioral Health Liaison, you will be the vital link between our dedicated clinical treatment team and third-party payers, ensuring that every patient receives the appropriate treatment they deserve. Your role will include:

Securing Authorizations: Obtain initial behavioral health authorizations and conduct thorough concurrent reviews to keep our patients on the path to recovery. Collaborative Decision-Making: Work closely with the clinical treatment team to assess the need for denial of stay when patients no longer meet acute care criteria, facilitating timely and appropriate actions. Stay Informed: Maintain an up-to-date understanding of contract requirements for all third-party payor groups, ensuring compliance and optimal patient care. Track Progress: Monitor each patient’s treatment journey through inpatient, partial hospitalization, and Intensive Outpatient Programs (IOP), ensuring they receive the best possible support. Cultural Competence: Bring your knowledge of gender, cultural differences, and age-appropriate care to the forefront of Utilization Review, enhancing our approach to diverse patient needs.