Registered Nurse (RN) Case Management, Utilization Manager, JBA

Registered Nurse (RN), Case Manager- Utilization Manager

Location: Joint Base Andrews (JBA), MD

Position Type: Full time (40 hours/week), hourly.

FLSA Status: Non-exempt

Education Level: ADN

Job Category: Health Care

Our Company Promise:

We are committed to providing our Employees a stable work environment with equal opportunity for learning and personal growth. Vighter's Mission is to provide efficient, fast, high-quality healthcare staffing to our clients. Our Culture's 5 key elements are crucial to the effectiveness of our employees in accomplishing our mission. These elements are:

Dependability

Integrity

Personability

Transparency

Responsiveness

Creating and cultivating this Culture within the organization is our commitment to our employees. Above all, Vighter employees will be provided the same concern, respect, and caring attitude that they are expected to share externally with every Vighter Client and Customer.

Summary:

Vighter is recruiting a Registered Nurse (RN) Case Manager-Utilization Management to provide patient care and administrative support at Joint Base Andrews, Maryland. In accordance with established policies, procedures, protocols, and guidelines, while supporting the healthcare needs of Service Members, their families, and Veterans.

Vighter is a Service Disabled, Veteran Owned Small Business that is accredited by both the Joint Commission and ISO-9001. With our dedication to continuous improvement, Vighter assists in the provision of the highest standards of care.

Principal Accountabilities:

Perform Utilization Management and Utilization Review activities.

Review care for medical necessity, appropriateness, quality, and cost effectiveness.

Conduct prospective, concurrent, and retrospective reviews.

Monitor inpatient length of stay (LOS) and planned inpatient/outpatient procedures.

Review referrals, appointments, diagnostic testing, procedure, pharmacy and other services.

Identify overutilization, underutilization, trends, and opportunities for improvement.

Collect and analyze utilization data, metrics, and healthcare outcomes.

Manage and monitor referrals through MHS GENESIS and applicable referral systems.

Verify beneficiary eligibility through DEERS.

Coordinate with TRICARE, MTF departments, providers, Case Managers, and outside agencies.

Monitor civilian hospital admissions for Active Duty, Reserve, and Guard members.

Participate in interdisciplinary, utilization management, and care coordination meetings.

Maintain required medical record documentation, coding, tracking logs, and reports.

Follow applicable MTF, DoD, HIPAA, quality, safety and infection-control requirements.

Complete required EMR, MTF orientation, and Utilization Management training.

Support quality improvement, patient safety, and process improvement initiatives.

Knowledge and Skills:

Knowledge of HIPAA, AAAHC, The Joint Commission and Clinical Practice Guidelines.

Knowledge of APGs, DRGs, ICD, CPT, InterQual, and/or Milliman Care Guidelines.

Proficient with Microsoft Office, Outlook, and electronic medical records.

Ability to perform prospective, concurrent, and retrospective utilization reviews.

Strong clinical assessment, critical-thinking, communication, and problem-solving skills.

Ability to evaluate medical necessities and appropriate use of healthcare resources.

Education:

Associate Degree in Nursing (ADN) from an ACEN- or CCNE-accredited nursing program.

Qualifications:

Minimum of three (3) years of direct patient care nursing experience.

Minimum of two (2) recent, consecutive years in utilization management, utilization review, or case management.

Current, active, and unrestricted Registered Nursing license in any U.S. state or jurisdiction.

Current Basic Life Support (BLS) certification is required.

Certified or certification-eligible in a relevant specialty, such as Managed Care Nursing, Nursing Case Management, Ambulatory Care Nursing, Medical-Surgical Nursing, or Informatics Nursing.

Experience with Patient Advocacy, Patient Privacy, and Customer Relations.

Duty Hours / On-call Requirements:

The expected duty hours for this position are 8 hours per day and 5 days per week. However, this position supports 24/7 operations which may require work to be conducted at night and on weekends.

Work Environment:

Location: Joint Base Andrews, MD.

Supportive team of healthcare professionals and administrative staff.

Opportunity to work with diverse populations, including Service Members, Veterans, retirees and their families.

Travel:

As required to satisfy the contractual obligations. Commuting is non-compensatory. All official travel is government funded.

Benefits:

Competitive hourly rate + health and welfare paid in cash.

A comprehensive benefits package, with Medical, Dental, and Vision insurance available for W2 full-time employees.

Company-paid basic Life and AD&D insurance. Best in class rates for Voluntary life insurance.

Vacation accrual and paid holidays (Per SCA Rules).

Physical Requirements:

Must be able to stand or sit for more than 8 hours per day.

Must be able to use an elevator or walk up & down stairs.

Must be able to lift up to 40 pounds and carry up to 10 feet.

Must be able to routinely grasp or handle objects, use finger dexterity, bend elbows/knees and reach above and below shoulders.

Must be able to read and interpret handwritten and typewritten print.

Must be able to communicate by voice and detect sound by ear.

Must be able to perform duties in an indoor office or outdoor environment.

Must be able to pass a criminal background investigation.

Must undergo Urine Drug Screening (UDS).

Must be a Citizen of the United States or legally authorized to work in the United States of America.

Vighter LLC is an equal opportunity employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status, or any other characteristic protected by law.