Registered Nurse - Utilization Management

Job Description

Job Description

Registered Nurse - Utilization Management

SITE OF SERVICE

Seymour Johnson Air Force Base, NC. This position provides utilization management nursing services supporting the military treatment facility and its beneficiaries.

HOURS

Monday through Friday: 0630-1730

POSITION OVERVIEW

The Registered Nurse - Utilization Management provides clinical review and care coordination services at Seymour Johnson AFB. This is a non-personal services position that does not involve hands-on patient care. The RN-UM ensures appropriate utilization of healthcare resources, conducts medical necessity reviews, and coordinates care transitions. This position works independently and is not subject to day-to-day Government supervision comparable to military or civil service personnel.

POSITION QUALIFICATION/REQUIREMENTS

• Degree: Graduate of an accredited nursing program (Associate's, Diploma, or Bachelor's degree in Nursing)

• Licensure: Current, unrestricted Registered Nurse license in North Carolina (no licensure portability for non-personal services)

• Case Management Certification: Must be certified or certification-eligible in relevant specialty such as Certified Managed Care Nurse (CMCN) through American Board of Managed Care Nurses, or certification through American Nurses Credentialing Center in Informatics Nursing, Ambulatory Care Nursing, Medical-Surgical Nursing, or Nursing Case Management

• Other Certification: Current Basic Life Support (BLS) certification.

• Experience: Current experience required is three years within the last four years as a

registered nurse in utilization management

• Citizenship: U.S. Citizen required

• Background: Must pass security investigation; SF-85 required

DUTIES

• Conduct utilization reviews to ensure medical necessity and appropriateness of care

• Review and process referrals for specialty care and outside services

• Perform concurrent and retrospective reviews of inpatient and outpatient services

• Coordinate with healthcare providers to optimize patient care and resource utilization

• Apply clinical criteria and guidelines (InterQual, Milliman, etc.) to assess level of care

• Identify and address potential quality of care issues

• Document review activities and decisions in accordance with regulatory requirements

• Collaborate with case managers, social workers, and discharge planners

• Communicate with TRICARE contractors and regional health commands as needed

• Analyze utilization data and identify trends for process improvement

• Ensure compliance with DHA, TRICARE, and MTF policies and procedures

• Participate in utilization management committee meetings and quality initiatives

HEALTH REQUIREMENTS

• TB Screening: Negative TB skin test within 12 months (if positive, negative chest X-ray with clearance letter)

• Tdap: Proof of immunization required prior to start

• Additional immunizations as required by MTF policy

SPECIAL REQUIREMENTS/SKILLS

This is a non-personal services position; the Government will not supervise or control the method by which the contractor performs required tasks. Strong knowledge of utilization management principles, TRICARE benefits and policies, and military health system operations preferred. Proficiency with electronic health records and utilization management software required. Excellent analytical, communication, and documentation skills essential. Must complete all agency-specified training requirements. Planned absences require 7 days advance notice to the COR.

LUKE is an Equal Opportunity Employer

LUKE is proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other protected class.

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