RN Utilization Management – Outpatient (No Nights)

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

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.