Rutgers, The State University of New Jersey is seeking a Staff Nurse for the Interim Managing Entity Program at Rutgers, University Behavioral Health Care.
The primary purpose of the Staff Nurse is to provide a nursing assessment of all clinical information submitted by providers of care when conducting clinical utilization reviews and provides guidance from a nursing perspective to utilization management staff regarding admission into all levels of care, especially Ambulatory and Inpatient Withdrawal Management, based on a determination of medical necessity and the appropriateness of the level of care, continuing length of stay requests, retrospective stay requests and issues related to provider requests for authorizations for treatment that meets utilization management criteria.
Identifies and evaluates client clinical information necessary to pre-authorize admission to care, especially admission to both Ambulatory and Inpatient Withdrawal management, and to continued lengths of stay, and retrospective stays and evaluates the quality of care according to pre-established criteria.
Assesses level of risk for self-harm and harm to others for all clients and conducts procedures that assure appropriate level of care placement for all at risk clients.
Documents initial nursing assessment and all relevant clinical information in shared client data base in a timely manner, as evidenced by supervisory review.
Consults with Supervisor regarding referrals to and consultation with the Medical Physician Advisor regarding all denials of authorization for care to assure proper review of all reconsideration of denials for pre-authorization, continued stay authorization and retrospective authorization.
Provides guidance from a nursing perspective to Access Center staff regarding the appropriate referral to treatment of a consumer in need of behavioral services especially for Ambulatory and Inpatient Withdrawal Management.
Obtains client clinical information in order to substantiate medical necessity for and appropriateness of treatment requested by conducting reviews of client clinical information submitted by providers, through communications with provider clinician staff via telephone, email and/or fax and when required by attending provider staffing and treatment planning meetings.
Assists the Supervisor and report-generating staff with data collection pertinent to the procedures to approval and deny authorization for treatment and for reconsideration/appeals of denials for admissions to care, continuing lengths of stay and/or retrospective authorization of care.
Assists in the obtaining of utilization management statistical data in the absence of the Supervisor and report generating staff.
Assists in preparation of utilization review monthly reports especially those related to both Ambulatory and Inpatient Withdrawal Management.
Documents all Incident reports on Incident report form and tracks special categories of incidents to identify and document trends within pre-established timeframes, as noted by Supervisor.
Understands and adheres to Rutgers' compliance standards as they appear in RBHS's Corporate Compliance Policy, Code of Conduct and Conflict of Interest Policy.
Performs other related duties as assigned.
Minimum Education and Experience:
Current license to practice as a Registered Nurse in the State of New Jersey.
Strong clinical nursing experience in behavioral healthcare.
Command of and experience with DSM diagnoses and ASAM.
Required Knowledge, Skills, and Abilities:
Ability to provide psychiatric nursing and to use the nursing process.
Ability to relate to clients, direct non-professional staff and request help when needed.
Effective communication and problem solving skills.
PC literate with proficiency in word processing.
Experience in managed behavioral healthcare.
Familiarity and experience with NJSAMS.
Physical Demands and Work Environment:
Physical Demands: Position requires standing 2/3 of the time, walking 2/3 of the time, sitting 1/3 of the time, use of hands to finger, handle or feel 2/3 of the time, reach with hands and arms 1/3 of the time, stoop, kneel, crouch, or crawl 1/3 of the time, talk or hear over 2/3 of the time. Manual dexterity and intermittent physical exertion when performing job activities. No special vision requirements. Ability to lift or exert up to 25 lbs.
Work Environment: Business office with moderate noise (e.g. computers and printers, light staff traffic and communication).
Rutgers, The State University of New Jersey, is a leading national public research university and the state's preeminent, comprehensive public institution of higher education. Rutgers is dedicated to teaching that meets the highest standards of excellence; to conducting research that breaks new ground; and to turning knowledge into solutions for local, national, and global communities. As it was ...at our founding in 1766, the heart of our mission is preparing students to become productive members of society and good citizens of the world. Rutgers teaches across the full educational spectrum: preschool to precollege; undergraduate to graduate and postdoctoral; and continuing education for professional and personal advancement. Rutgers is New Jersey's land-grant institution and one of the nation's foremost research universities, and as such, we educate, make discoveries, serve as an engine of economic growth, and generate ideas for improving people's lives.