Clinical Nurse Utilization Manager (RN)

Clinical Nurse (RN), Utilization Manager

ERP International is seeking a Clinical Nurse (RN), Utilization Manager for a Full-Time position in support of the 42 Medical Group at Maxwell AFB, AL. Join our team of exceptional health care professionals across the nation. ERP International is honored to be named a 2026 Top Workplace by WTOP News! 7 Years Running. Excellent Compensation & Exceptional Comprehensive Benefits! Paid Vacation, Paid Sick Time, Plus 11 Paid Federal Holidays! Medical/Dental/Vision, STD/LTD/Life, and Health Savings Account available! Annual CME Stipend and License/Certification Reimbursement! Matching 401K!

ERP International is a nationally respected provider of health, science, and technology solutions supporting clients in the government and commercial sectors. We provide comprehensive enterprise information technology, strategic sourcing, and management solutions to DoD and federal civilian agencies in 40 states. Founded in 2006, ERP is headquartered in Laurel, MD and maintains satellite offices in Montgomery, AL and San Antonio, TX - plus project locations nationwide. ERP is an Equal Opportunity Employer - Disability and Veteran.

Responsibilities

Work Schedule: Monday - Friday, 9 hours between 7:00am and 5:00pm, including a one hour lunch

Core Duties:

• Uses data-driven processes to prospectively and retrospectively identify indicators of ineffective or inefficient delivery of care and to describe MTF resource utilization patterns. Briefs applicable data/slides to provider staff, executive staff, newcomers, as appropriate.
• Plans and performs reviews IAW established indicators and guidelines to provide high-quality, cost-effective care. Assist MTF officials to ensure Health Service Inspection standards are met at the operational level.
• Leverage evidence-based clinical decision support tools to determine the appropriate level of care and improve resource utilization.
• Maintain reports on which cases have been denied or received reduced third-party payments and reports provider profiles to the MTF management for corrective action as needed.
• Educates MTF staff on the referral process and tools available to determine appropriate level of care to achieve optimal patient outcomes. Identify, analyze and make recommendations to resolve problems and situations regarding referrals.
• Notifies the PCM team of known admissions, discharges, and emergency room/urgent care clinic visits. Conducts discharge planning IAW accrediting agency standards for all eligible beneficiaries.
• Assists in the development and implementation of a comprehensive Utilization Management plan/program for beneficiaries within MTF's goals and objectives. This plan is based on using the 12-step approach described in the DoD Medical Management Guide.
• Serves as a liaison with higher headquarters, TRICARE Regional Office, MTF national accreditation organization, professional organizations, and community health care facilities concerning Utilization Management. Participates in in-services and continuing education programs.
• Participate in MTF Medical Management, Population Health, Quality, and Care Coordination meetings to ensure alignment and integration of UM activities and promote MTF health strategies.

Qualifications

Minimum Qualifications: Degree/Education: Bachelor's degree of Nursing. Graduate from a college or university accredited by Accreditation Commission for Education in Nursing (ACEN), the Commission on Collegiate Nursing Education (CCNE) Incumbent degree may be considered if lower than required. Experience: At least 24 months of full-time experience within the last 36 months in Utilization Management. Licensure: Current, full, active, and unrestricted license to practice as a Registered Nurse. Life Support Certification: Possess current ARC or AHA BLS Healthcare Provider certification. Security: Must possess ability to pass a Government background check/security clearance.