Registered Nurse - Utilization Management

ADP, Inc.; Virginia (MN); On-site; USD 66,000 - 73,000; Full time

Job summary

Professional Performance Development Group (PPDG) seeks a Registered Nurse - Utilization Management to support Langley Air Force Base operations. The RN reviews medical necessity, coordinates care with the care team, and supports case management to promote quality outcomes for military beneficiaries.

The role emphasizes utilization management, care coordination, and adherence to DHA, DoD, and facility requirements.

Qualifications

• RN with minimum 1 year nursing experience after graduation.
• Active RN license in the United States.
• Knowledge of utilization management and case management.

Responsibilities

• Perform utilization management reviews for medical necessity.
• Coordinate patient care with physicians, nurses, and case managers.
• Review admissions, referrals, procedures and treatment plans.
• Assist discharge planning and continuity-of-care activities.
• Maintain accurate documentation and protect patient confidentiality.

Skills

Utilization management

Case management

Nursing

Clinical assessment

Communication

Education

Associate Degree in Nursing

Tools

Electronic health records (EHR)

EMR systems

Job description

If you are unable to complete this application due to a disability, contact this employer to ask for an accommodation or an alternative application process.

Full Time MED-WD JB Langley-Eustis, Ft. Eustis, VA, US 1 Attachments

Salary Range: $48.10 To $53.19 Hourly

Location: Langley AFB, VA

Make a Difference in Military Healthcare

Professional Performance Development Group (PPDG) is seeking a dedicated Registered Nurse - Utilization Management to support healthcare operations at Langley Air Force Base. This position plays a critical role in ensuring appropriate utilization of healthcare resources, coordinating patient care, supporting case management activities, and promoting quality healthcare outcomes for military beneficiaries. Based on the Registered Nurse and Registered Nurse Case Manager minimum qualifications and core duties identified

Position Summary

The Registered Nurse - Utilization Management provides utilization management, care coordination, and case management support services. Working collaboratively with physicians, nurses, case managers, and multidisciplinary healthcare teams, the RN reviews healthcare services for medical necessity, resource utilization, quality outcomes, and continuity of care.

Minimum Qualifications

Education

• Associate Degree in Nursing.
• Graduate from a college or university accredited by the Accreditation Commission for Education in Nursing (ACEN) or the Commission on Collegiate Nursing Education (CCNE).
• No educational equivalency substitutions are permitted under this labor category.

Licensure

• Current, full, active, and unrestricted Registered Nurse license.

Experience

• Minimum one (1) year of nursing experience after graduation.

Required Certifications

• Current Basic Life Support (BLS) certification.
• Utilization Management and Case Management certifications may be required based on assignment, including:
  • Certified Case Manager (CCM)
  • Certified Disability Management Specialist (CDMS)
  • Certified Rehabilitation Registered Nurse (CRRN)
  • Registered Nurse Case Manager (RN-NCM)
  • Care Manager Certified (CMC)
  • Other related case management certifications.

Work Authorization

Candidates must be legally authorized to work in the United States and meet applicable contract requirements.

Essential Duties and Responsibilities

• Perform utilization management reviews and evaluate healthcare services for medical necessity and appropriateness.
• Participate in all phases of utilization management and case management programs.
• Coordinate patient care with physicians, nurses, case managers, social workers, and ancillary healthcare staff.
• Review admissions, referrals, procedures, and treatment plans.
• Assist with discharge planning and continuity-of-care activities.
• Participate in utilization management meetings, case conferences, and performance improvement initiatives.
• Monitor patient progress and evaluate healthcare outcomes.
• Analyze patient-care and utilization data to identify opportunities for improvement.
• Support development and implementation of clinical practice guidelines, algorithms, and utilization management tools.
• Promote efficient use of healthcare resources while maintaining quality patient care.
• Maintain accurate documentation and protect patient confidentiality.
• Utilize electronic health records and healthcare information systems.
• Provide patient and caregiver education regarding care plans and healthcare services.
• Ensure compliance with DHA, DoD, facility, and regulatory requirements.
• Participate in training, professional development, and quality improvement activities.
• Perform additional utilization management and nursing duties as assigned.

Knowledge, Skills, and Abilities

• Knowledge of utilization management, case management, and care coordination practices.
• Strong clinical assessment and critical thinking skills.
• Knowledge of healthcare regulations, accreditation standards, and quality improvement methodologies.
• Ability to evaluate medical necessity and healthcare resource utilization.
• Effective communication and collaboration skills.
• Proficiency in electronic medical record systems and healthcare databases.
• Strong organizational and documentation skills.

Attachments (1)

Job Description - Registered Nurse Utilization Management Langley AFB.pdf