Registered Nurse (RN) - Utilization Management

Registered Nurse Utilization Management

Spectrum Healthcare Resources has a potential opportunity for a Registered Nurse Utilization Management at Lackland AFB in San Antonio, TX.

This contract position offers:

• Monday-Friday 730am-430pm
• Outpatient Clinic
• No Nights, Weekend or Holidays
• No On-Call
• Stable Patient Population
• Paid time off and paid holidays
• Benefits package including Medical, Dental, Vision and 401(k) and more

Requirements:

• Associate Degree of Nursing. Must possess a bachelor's degree in relevant health sciences or health informatics from an accredited university.
• Graduate from a college or university accredited by the ACEN or CCNE
• Active RN license in any state
• 2+ years of clinical and utilization management RN experience
• Basic Life Support Certification from American Heart

Core Duties:

• Supports a comprehensive MTF Utilization Management plan/program as prescribed in the DoD Medical Management Guide and by the MTF Utilization Management Director.
• Actively and retrospectively reviews medical cases to confirm receipt of appropriate care, monitor for patterns/trends and develop action plan for areas requiring improvement.
• Reports on utilization patterns; briefs provider staff and executive staff.
• Maintains reports on which cases have been denied or received reduced third party payments and reports provider profiles to the MTF management for corrective action.
• Participates on multi-disciplinary teams to resolve recurring problems in the healthcare delivery process for care within or outside the MTF including referrals
• Research and Analysis: Investigate and resolve queries from MTF clinics by analyzing reports and data.
• Education and Training: Provide education and guidance on reporting systems and tools to ensure effective utilization by clinic staff.

Spectrum Healthcare Resources