Registered Nurse - Utilization Management (RN-UM)

Le CYR Consulting; Fort Carson (CO); On-site; USD 60,000 - 80,000; Full time

Job summary

A healthcare consulting firm is seeking a Registered Nurse for Utilization Management. This role involves conducting reviews to ensure medical necessity of services, collaborating with healthcare providers, and analyzing utilization data. Ideal candidates must possess a nursing degree, licensing, and experience in utilization management and clinical nursing. Strong analytical and communication skills are essential. The position is based in Fort Carson, Colorado, with a schedule from Monday to Friday.

Qualifications

• Minimum of 1 year of Utilization Review/Management experience.
• Minimum of 3 years of clinical nursing experience.
• Current, full, active, unrestricted RN license in a U.S. jurisdiction; BLS certification required.

Responsibilities

• Conduct utilization management reviews to ensure healthcare services are medically necessary.
• Act as a liaison with providers and TRICARE contractors to ensure appropriate care.
• Prepare and analyze reports on utilization data and healthcare trends.

Skills

Analytical skills

Communication skills

Organizational skills

Education

Graduate of an accredited school of nursing (BSN preferred)

Job description

Job Title:Registered Nurse -Utilization Management (RN-UM)

Location:Colorado Military Health System (CMHS), Fort Carson, CO, 80913

Tentative Start Date:December 1, 2025

Work Schedule:Monday–Friday, 8-hour shifts between 0600–1700, excluding federal holidays

Qualifications:

• Education:Graduate of an accredited school of nursing (BSN preferred).
• Experience:
  • Minimum of 1 year of Utilization Review/Management experience.
  • Minimum of 3 years of clinical nursing experience.
  • Experience with TRICARE and military healthcare systems is highly desirable.
• License/Certification:Current, full, active, unrestricted RN license in a U.S. jurisdiction; BLS certification required.
• Other Requirements:Must be a U.S. Citizen; excellent analytical, communication, and organizational skills.

Documents Required for Submission:

• Updated Resume (With all gaps explained)
• Current, full, active, unrestricted license as a Registered Nurse in any U.S. state or territory.
• Basic Life Support (BLS) certification.

Responsibilities:

• Conduct utilization management reviews to ensure healthcare services are medically necessary, appropriate, and cost-effective.
• Act as a liaison with providers, referral centers, and TRICARE contractors to ensure patients receive care at the appropriate level and location.
• Apply clinical knowledge to review medical necessities for specialty referrals, inpatient admissions, and outpatient services.
• Prepare and analyze reports on utilization data and healthcare trends to identify inefficiencies or over/under-utilization.
• Identify high-cost or complex cases, collaborating with case managers and providers to optimize patient care planning.
• Ensure patient care complies with TRICARE access-to-care standards and DHA utilization policies.
• Educate providers and staff on referral management processes and utilization criteria.
• Support process improvement initiatives to enhance referral and utilization management across the CMHS.
• Maintain accurate documentation of all utilization management activities in EHR systems.
• Protect patient confidentiality and comply with HIPAA and DoD privacy requirements.