FSR (Federal Staffing Resources)
  • Tyndall AFB, FL, USA
  • Full Time

Registered Nurse (RN) - Utilization Management job in Panama City, FL.

The Registered Nurse (RN) - Utilization Management is based on Tyndall Air Force base and is a civilian position. Civilian and military personnel work together in the extensive military medical system. The hospitals and medical clinics provide services to the active duty military service members, military retirees, and their families and provide a full range of medical services. 

Our employees are our best assets! Come join our team of healthcare professionals where you are valued.

  • Monday-Friday
  • Days Only!
  • Fantastic PTO accrual rate
  • Competitive Compensation
  • Benefit Package (health, dental, and vision plans)
  • Dedication Program Manager to support your employment

 

Registered Nurse (RN) - Utilization Management job overview:

  • Develops and implements a comprehensive Utilization Management plan/program in accordance with the facility's goals and strategic objectives.
  • Performs data/metrics collection on identified program areas
  • analyzes and trends results, including over- and underutilization of healthcare resources
  • Identifies areas for improvement and cost containment.  Reports utilization patterns and provides feedback in a timely manner.
  • Analyzes medical referrals/appointments and general hospital procedures and regulations by monitoring specialty care referrals for appropriateness, covered benefits, and authorized surgery/medical procedures, laboratory, radiology and pharmacy.
  • Performs medical necessity review for planned inpatient and outpatient surgery.
  • Reviews previous and present medical care practices for patterns; trends incidents of under-or over-utilization of resources incidental to providing medical care.
  • Acts as referral approval authority for designated referrals per local/AF/DoD/national guidance and standards.  Refers all first-level review failures to the SGH or other POC for further review and disposition.
  • Verifies eligibility of beneficiaries using Defense Eligibility Enrollment Reporting System (DEERS).  
  • Ensures and monitors specialty care referrals for appropriateness, medical necessity, and if the appointment, diagnostic testing, or procedure requested is a covered benefit.
  • Receives and makes patient telephone calls, written, or e-mail correspondence regarding specialty clinic appointments and referrals following MTF-specific processes.
  • Routinely monitors referral management Composite Health Care System (CHCS) queue to ensure patients referrals are appointed and closed out.
  • Ensures Line of Duty paperwork is on file prior to authorization for all reserve and guard member referrals.
  • Keeps abreast of MTF and local market services and capabilities.  Updates capability report as needed/directed.
  • Conducts referral reconciliation report as directed, identifying all open referrals and provides notification to appropriate personnel for resolution.
  • Monitors active duty, reserve/guard admissions to civilian hospitals and notifies Case Manager and Patient Administration Element as required.
  • Serves as a liaison with headquarters, TRICARE regional offices, MTF staff and professional organizations concerning Utilization Management practices.

Registered Nurse (RN) - Utilization Management job qualifications:

  • Associates Degree of Nursing 
  • RN License: Current, full, active, and unrestricted license
  • 36 months of nursing experience in a direct patient care clinical setting
  • 2 years of recent consecutive utilization management, utilization review or case management experience 
  • Certified/certification eligible in relevant specialty:
    • Certified Managed Care Nurse through the American Board of Managed Care Nurses
    • American Nurses Credentialing Center: Certified Informatics Nursing, Ambulatory Care Nursing, Medical-Surgical Nursing or Nursing Case Management

 

 

Position contingent upon contract award. Incumbents highly encouraged to contact us! Come join our team of amazing team of healthcare professionals dedicated to serving the military community. 

 

 


FSRpeople.com

FSR provides healthcare professionals to government healthcare facilities supporting active military service members, retirees, and their families nationwide. Since 2004, FSR has matched talented individuals to organizations to create mutually beneficial, sustainable partnerships. FSR is a well-established, award winning organization built with committed professionals who have a unified vision of helping others to succeed and thrive.

We invite you to join our team and grow with us!

FSR is a woman-owned, minority, small business based out of Maryland.

 

Federal Staffing Resources dba FSR is an Equal Opportunity Employer: disability/veteran/military spouse

This contractor and subcontractor shall abide by the requirements of 41 CFR 60-1.4(a), 60-300.5(a) and 60-741.5(a). These regulations prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, religion, sex, sexual orientation, gender identity or national origin. Moreover, these regulations require that covered prime contractors and subcontractors take affirmative action to employ and advance in employment individuals without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status or disability.

FSR (Federal Staffing Resources)
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