Utilization Review Nurse - Exeter, RI

At Phoenix House, change is something we embrace every day as part of our values to deliver exceptional care. Phoenix House provides individualized, holistic drug and alcohol addiction treatment, with a legacy spanning nearly 50 years. We are passionate about healing individuals, families and communities challenged by substance use disorders and related mental health conditions.

Phoenix House supports the mission through a holistic approach that focuses on the distinct mental, physical, and social needs of every person; innovation of best-in-class and evidence-based prevention, treatment, and recovery programs; and, the promotion of greater understanding of addiction. Our devoted staff are committed to treating the whole person-and come from all fields.

We operate personalized, strength-based, gender-responsive programs while living the values and being accountable for our commitments. Being introspective and becoming part of the solution is integral to every interaction and person we touch. As 'One Phoenix House' we believe in having fun along the way - embracing 'progress not perfection' as our journey continues. 


The Utilization Reviewer/Registered Nurse collects, analyzes, and provides pertinent, timely clinical information including medications, to payer sources and external utilization review personnel for authorization of inpatient stay and services of the initial, concurrent, and discharge authorizations and reviews which are completed through interactions with the client's insurance companies during normal business hours including, nights, weekend and holidays as necessary.


·  Obtain proper authorization for each admitted patient.

·  Review and monitor each step of the authorization process to proactively identify and resolve problems.

·  Interact with physicians and therapists on an on-going basis to assure patient assessment and treatment planning and appropriately gather all clinical information to determine the medical necessity of requested healthcare and to assure services are accurately and consistently reflected in facility documentation.

·  Maintain a daily record in the Welligent system of the concurrent review process and inform the treatment team of the authorization status of each assigned patient.

·  Help patients access the full range of their benefits through creative utilization.

·  Work to extend patients treatment stay as needed or deemed medically appropriate through maximization of benefits and minimizing appeals.

·  Assess each patient's individual needs on the basis of assessment and data collection to ensure proper admission.

·  Implement doctor's orders, administer specified medication, monitor and record vital signs, and maintain medical/ nursing records.

·  Utilize Welligent effectively and efficiently.

·  Direct duties of Treatment Assistants.

·  Observe patients and document their responses to treatment.

·  Communicate with counseling staff on a regular basis regarding patient's progress and treatment plans.

·  Discharge patients in accordance with established policy.

·  Carry out administrative procedures in compliance with program policies.

·  Serve as role model.

·  Ensure program compliance with all CARF, DEA, DOH, BHDDH, local, state and federal regulations and licensing requirements.

·  Complete all reviews including initial, concurrent and discharge with insurance company and input the authorizations into the Welligent system according to compliance.

·  Perform other duties as assigned.


To perform this position successfully, you must be able to perform each essential duty and responsibility satisfactorily.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential duties and responsibilities.  The requirements listed below are representative of the knowledge, skill and/or ability required. 

·  Knowledge obtained through attainment of applicable state Registered Nurse's license.

·  Skill in implementing nursing protocol.

·  Strong communication, documentation, clinical and critical thinking skills essential.

·  Working knowledge of utilization reviews.

·  Strong problem solving and decision making skills.

·  Strong typing and computer skills.

·  Skill in patient assessment.

·  Ability to assign and direct work.

·  Ability to carry out instruction and accurately document medical information.

·  Ability to work and communicate with others.


Clinically aware person who has experience in Utilization Review.




The physical demands described here are representative of those that must be met by an employee to successfully perform the essential duties and responsibilities of this position.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential duties and responsibilities.

REGULARLY REQUIRED:  to sit, use hands to finger, handle or feel objects, tools or controls; reach with hands and arms, and talk or hear.

OCCASIONALLY REQUIRED:  to stand, walk, stoop, kneel or crouch and lift and/or move up to 10 pounds


The work environment characteristics described here are representative of those an employee encounters while performing the essential duties and responsibilities of this position.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential duties and responsibilities.

The work environment is that of a detoxification facility for substance-abusing populations.

  • Exposure to clients infected with Hepatitis B, HIV, TB, or other Infectious Diseases
  • Business-related travel


Weekends and holiday hours may be required.

Phoenix House requires background checks, drug testing, TB testing, verification of employment history, reference checks and possibly a medical exam, prior to employment.

Phoenix House is an Equal Opportunity Employer providing equality of opportunity to all who are protected against discrimination by law, regulation or executive order, including veterans and individuals with disabilities. EEO is the Law: Applicants and employees are protected under Federal law from discrimination. Click www.dol.gov/ofccp/regs/compliance/posters/pdf/eeopost.pdf to learn more.


Job ID: 124