Clinical Nurse Utilization Manager (RN)

ERP International, LLC; Montgomery (AL); On-site; USD 75,000 - 95,000; Full time

Benefits offered by this job

Benefits package

Paid time off

Medical/Dental/Vision & HSA

CME stipend

401K matching

Job summary

ERP International, LLC is seeking a Clinical Nurse (RN), Utilization Manager for a full-time position supporting the 42 Medical Group at Maxwell AFB, AL.

Join a team of healthcare professionals providing care to military members, their families, and veterans. ERP emphasizes outstanding benefits, paid time off, CME stipends, and a 401K match.

Qualifications

• Bachelor’s degree in Nursing from ACEN/CCNE-accredited program.
• 24 months of full-time Utilization Management experience in past 36 months.
• Current, active RN license.
• ARC or AHA BLS Healthcare Provider certification.
• Ability to pass a government background check.

Responsibilities

• Identify indicators of ineffective care delivery using data-driven processes and brief staff on findings.
• Plan and perform reviews to ensure high-quality, cost-effective care per established indicators.
• Leverage decision support tools to determine appropriate level of care and improve utilization.
• Maintain reports on denials and provider profiles for corrective action by MTF management.
• Educate MTF staff on referrals and tools to determine appropriate level of care for optimal outcomes.
• Notify PCM team of admissions, discharges, and ED visits; conduct discharge planning per standards.
• Assist in developing and implementing a comprehensive Utilization Management plan.
• Serve as liaison with higher HQ, TRICARE RO, and accreditation bodies for UM.
• Participate in MTF Medical Management, Population Health, Quality, and Care Coordination meetings.

Skills

Utilization management

Nursing

Communication

Education

Bachelor's degree in Nursing

Job description

Overview

ERP International is seeking a Clinical Nurse (RN), Utilization Manager for a Full-Time position in supportof the 42 Medical Group at Maxwell AFB, AL.

Be the Best! Join our team of exceptional health care professionals across the nation. Come discover the immense pride and job satisfaction ERP Employees experience in providing care for our Military Members, their Families and Retired Military Veterans! 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!

About ERP International, LLC: ERP 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.