Memphis, Tennessee, United States
Reviewed patient admissions to determine medical necessity as directed by ASAM criteria. Collaborated with the multidisciplinary team to obtain required clinical information, supporting prior authorization determinations and individual inquiries. Determined medical necessity and appropriate level of care through utilization review processes and medical necessity. Remained up-to-date on various benefit plans, medical policies and state-specific clinical guidelines or criteria. Kept detailed documentation on all utilization reviews by using salesforce and Aura (EHR). Referred and conducted peer reviews for failure to meet ASAM criteria. Teaching ASAM and utilization review training new utilization review nurses job responsibilities Teaching ASAM and training new therapists how, where, and what needs to be documented to satisfy different insurance requests
Admitted and monitored patients while in detox sometimes in active withdrawal throughout their entire stay and until discharge. Identified symptoms of patients entering into delirium tremens and contacted the chain of command as needed, sometimes transferring patient to a higher level of care. Administered medications, monitoring patients for reactions and side effects. Oversaw patient admission and discharge processes to coordinate related paperwork. Updated charts throughout shifts with current, accurate information to maintain strict recordkeeping standards. Advocated for patients by supporting and respecting basic rights, values and beliefs. Responded to emergency situations with speed, expertise and level-headed approaches to provide optimal care, support and life saving interventions.