Registered Nurse (RN) - Utilization Management

Spectrum Healthcare Resources, Inc.; Town of Texas (WI); On-site; USD 75,000 - 100,000; Full time

Benefits offered by this job

Paid time off

Paid holidays

Medical, Dental, Vision

401(k)

Job summary

Spectrum Healthcare Resources, Inc. is seeking a Registered Nurse for Utilization Management at Lackland AFB, San Antonio, TX. The role emphasizes outpatient UM with no nights or on-call duties and includes PTO and holidays in a stable administrative environment.

Required are an ADN with a BS or health sciences/informatics background, ACEN/CCNE accreditation, active RN license, and 2+ years in clinical and UM roles, plus BLS certification. Relocation and military facility experience are a plus.

Qualifications

• RN license active in any state.
• 2+ years of clinical and utilization management RN experience.
• BLS Certification from American Heart Association.

Responsibilities

• Support a comprehensive MTF Utilization Management plan/program as prescribed by DoD guidance.
• Actively and retrospectively review medical cases to ensure appropriate care and identify improvement opportunities.
• Report on utilization patterns and brief provider and executive staff.

Skills

RN license

Utilization management experience

Basic Life Support (BLS)

Education

Associate Degree in Nursing (ADN)

Bachelor's degree in health sciences or health informatics

ACEN/CCNE accreditation

Job description

Job Description

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.

For More Information Contact:

Melissa Powell

719-528-7965

[e-mail]

Company Overview:

Spectrum Healthcare Resources (SHR) was established in 1988 to deliver systems and processes designed to meet the unique needs of Militaryand VA Health Systems. SHR is a leading organization that provides physician and clinical staffing and management services to United States Military Treatment Facilities, VA clinicsand other Federal Agencies through various contracting vehicles. A Joint Commission Health Care Staffing Services firm, SHR isthe military staffing division of TeamHealth, a Nationwide organization that serves 850 civilian and military hospitals with a team of 9,600 affiliated health care professionals. EOE/Disabled/Veterans