Registered Nurse (RN) - Utilization Management

Spectrum Healthcare Resources; Town of Texas (WI); On-site; USD 80,000 - 115,000; Full time

Benefits offered by this job

Paid time off

Paid holidays

Medical, Dental, Vision

401(k)

Job summary

Spectrum Healthcare Resources has an opportunity for a Registered Nurse Utilization Management at Lackland AFB in San Antonio, TX. The position is a Monday-Friday day shift in an outpatient clinic with no nights, weekends, or holidays and no on-call requirements.

The role emphasizes utilization management support, case reviews, and collaboration with multi-disciplinary teams to optimize patient care. A nursing license and BLS are required, with 2+ years in related experience.

Qualifications

• Associate Degree in Nursing is required.
• Bachelor's in health sciences or health informatics from an accredited university preferred.
• Active RN license in any state.
• 2+ years in clinical and utilization management RN experience.
• Basic Life Support certification.

Responsibilities

• Supports a comprehensive Utilization Management plan/program as prescribed by DoD and MTF Utilization Management Director.
• Actively and retrospectively reviews medical cases to ensure appropriate care.
• Reports on utilization patterns and briefs staff and leadership.
• Maintains reports on denials or reduced payments and advises management on corrective actions.
• Participates on multi-disciplinary teams to resolve care delivery issues.
• Research and analyze reports and data to address queries from MTF clinics.
• Provide education and guidance on reporting systems and tools to improve utilization.

Skills

Utilization Management

RN clinical experience

Education: Baccalaureate/ACEN-CCNE

Basic Life Support

Education

Associate Degree in Nursing

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.

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