FSR (Federal Staffing Resources)
  • Hurlburt Field, FL, USA
  • Full Time

 

Registered Nurse RN) - Utilization Management job in Fort Walton Beach, Florida. 

The Registered Nurse (RN) - Utilization Management job is within the military medical system 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:

Inpatient: 

  • 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; and performs concurrent review to include length of stay (LOS) for the facility's inpatients using appropriate criteria. 
  • Reviews previous and present medical care practices for patterns; trends incidents of under-or over-utilization of resources incidental to providing medical care.
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  • Gather necessary information, determine the medical necessity of services ordered or rendered, and determine appropriateness of certain levels of care IAW approved decision support tool. 
  • Improvement initiatives. Promote and contribute quality performance, performance improvement programs, and nursing practice in a setting that supports professional practice and sets a positive example

Outpatient: 

  • Acts as referral approval authority for designated referrals per local/AF/DoD/national guidance and standards. 
  • Verifies eligibility of beneficiaries
  • Obtains pertinent information from patients/callers and updates data in CHCS, AHLTA, local referral database, and other office automation software programs as appropriate and directed. 
  • Ensures and monitors specialty care referrals for appropriateness, medical necessity, and if the appointment, diagnostic testing, or procedure requested is a covered benefit according to appropriate health plan. 
  • 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 

Registered Nurse (RN) - Utilization Management Job Qualifications:

  • BLS
  • Associates Degree of Nursing
  • Graduate from a NLNAC or CCNE accrediated college or university 
  • RN Licensure: Current, full, active, and unrestricted. Any U.S. state.
  • Certified/certification eligible in relevant specialty, such as Certified Managed Care Nurse, Certified Informatics Nursing, Ambulatory Care Nursing, Medical-Surgical Nursing or Nursing Case Management.

  • Clinical competency within the past two years
  • Computer competency

 

 Position contingent on contract award. Incumbents HIGHLY encourage to contact us! Come join our team of healthcare professionals! 

 


www.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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