Registered Nurse - Utilization Management (RN-UM)

Le CYR Consulting; Fort Carson (CO); On-site; USD 85,000 - 115,000; Full time

Job summary

Le CYR Consulting in Fort Carson, CO is seeking a Registered Nurse - Utilization Management (RN-UM) for a full-time role starting December 1, 2025. Work schedule is Monday–Friday, 8-hour shifts between 0600–1700, excluding federal holidays.

The role requires an active RN license in the U.S. and BLS certification, with at least 3 years of clinical nursing experience and 1 year in utilization management; BSN preferred and TRICARE/military healthcare experience is highly desirable.

Qualifications

• RN licensure in the U.S. with current status
• BLS certification required
• BSN preferred
• Minimum 1 year Utilization Review/Management experience
• Minimum 3 years clinical nursing experience
• Experience with TRICARE and military healthcare systems desirable
• Must be a U.S. Citizen; strong analytical, communication, and organizational skills

Responsibilities

• Conduct utilization management reviews to ensure medical necessity, appropriateness, and cost effectiveness.
• Act as liaison with providers, referral centers, and TRICARE contractors to coordinate care.
• Apply clinical knowledge to review medical necessities for referrals, admissions, and outpatient services.
• Prepare and analyze utilization reports to identify inefficiencies or over/under-utilization.
• Identify high-cost or complex cases and collaborate with case managers and providers.
• 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.
• Maintain accurate documentation of utilization management activities in EHR systems.

Skills

Utilization Review

Clinical Nursing

Communication

Analytical Skills

Organizational Skills

Education

Bachelor of Science in Nursing (BSN)

Tools

EHR systems

Job description

Ft Carson, CO

Full Time

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

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.