FSR (Federal Staffing Resources)
  • Colorado Springs, CO, USA
  • Full Time

 

Registered Nurse (RN) - Utilization Management job in Colorado Springs, CO. 

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.

  • Fantastic PTO accrual rate
  • Competitive Compensation
  • Benefit Package (health, dental, and vision plans)

Registered Nurse (RN) - Utilization Management Job Overview:

  • Provides Utilization Management activities and functions by using MTF-specific Quality Improvement processes to identify areas for review from data, suspected problem areas, and input from departments/services within the facility. 
  • Prioritizes accordingly based on high dollar, high volume or problem prone diagnoses. 
  • Identifies gaps between desired and actual program outcomes and develops an action plan to fix gaps. 
  • Determines effectiveness of the plan and continually evaluates the impact of implementation. 
  • Incorporates applicable utilization review tasks to ensure patients receive the right care, at the right time, in the right place, with the right provider, at the right cost.  Collaborates with staff, facility departments, and outside agencies to determine the best, most cost-efficient care
  • Develops and implements a comprehensive Utilization Management plan/program in accordance with the facility's goals and 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.
  • 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.

 

 

Registered Nurse (RN) - Utilization Management Job Qualifications:

  • BSN preferred
  • Graduate from a NLN or AACN accredited college or university
  • RN license
  • Certification by a Utilization Management-specific program such as Certified Professional in Healthcare Management (CPHM) is desired.
  • BCLS
  • Computer competency
  • APGs, DRGs, ICD, CPT, InterQual, and/or Milliman Care Guidelines
  • One year of previous experience in Utilization Management is required.
  • Employment in a nursing field within the last 12 months is mandatory. 
  • 6 years of active clinical nursing practice is desired.
  • Experience in performing prospective, concurrent, and retrospective reviews to justify medical necessity for requested medical care and to aid in collection and recovery from multiple insurance carriers. Review process includes Direct Care and Purchased Care System referrals, inpatient unit rounds for clinical data collection, and providing documentation for appeals or grievance resolution.
  • Familiarity with Department of Defense (DoD), Federal, State, non-profit healthcare systems and organizations, to include DoD Tri-Service Military Healthcare Systems, TRICARE purchased care system, Medicare, Medicaid and the Veterans Administration (VA) is desired.

 

 

 

 Position contingent on contract award for 1/2019. 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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