FSR (Federal Staffing Resources)
  • Jacksonville, AR, USA
  • Full Time

Registered Nurse (RN) - Utilization Management job in Little Rock, Arkansas. 

The position is a civilian position providing services within the extensive military medical system, which provides services to active duty service members, military retirees, and their families. Civilian and military personnel work together in the hospitals and clinics. 

Registered Nurse (RN) - Utilization Management job highlights:

  • Monday-Friday
  • Days
  • Holidays off
  • PTO
  • Benefits (health, dental, and vision)

 

Registered Nurse (RN) - Utilization Management job overview:

  • Coordinate patient care in collaboration with a wide array of healthcare professionals. Facilitate the achievement of optimal outcomes in relation to clinical care, quality and cost effectiveness.
  • Ensure compliance with standards of care and practice in accordance with all established policies, procedures, and guidelines used in the MTF.
  • Develop and implement a comprehensive Utilization Management plan/program in accordance with the facility's goals and strategic objectives.
  • Perform data/metrics collection on identified program areas; analyze and trend results, including over- and underutilization of healthcare resources. Identify areas for improvement and cost containment. Report utilization patterns and provide 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 prospective, concurrent, and/or retrospective utilization review to assess whether aspects of a patients care is medically necessary and appropriately delivered for planned inpatient and outpatient surgeries.
  • Communicate and collaborate with a diverse group of people for the purpose of informing the healthcare team of plans/actions, for teaching/education to benefit the patient/family and organization.
  • Make referral appointments and arrange specialty care as appropriate.
  • Conduct research in support of improved practice and patient outcomes.

 

Registered Nurse (RN) - Utilization Management job qualifications:

  • Associates Degree of Nursing (ADN)
  • Graduate from a college or university accredited by NLNAC or CCNE
  • At least two years of total nursing experience in a direct patient care clinical setting
  • Must have utilization management, utilization review or case management experience for 24 recent consecutive months.
  • Must be knowledgeable in HIPAA, AAAHC, TJC, and CPGs
  • Must have a working knowledge of APGs, DRGs, ICD, CPT, and McKesson (InterQual) and/or Milliman Care Guidelines.
  • Must be able to perform prospective, concurrent, and retrospective reviews to justify medical necessity for requested medical care and to aid in collection and recovery from multiple insurance carriers.
  • Must be able to collect clinical data from inpatient and outpatient sources; provide documentation for appeals or grievance resolution; apply critical thinking skills and expertise in resolving complicated healthcare, social, interpersonal and financial patient situations; apply problem-solving techniques to articulate medical requirements to patients, families/care givers, medical and non-medical staff in a professional and courteous way.
  • Certified/certification eligible in relevant specialty, such as Certified Managed Care Nurse through the American Board of Managed Care Nurses or Certified Informatics Nursing, Ambulatory Care Nursing, Medical-Surgical Nursing or Nursing Case Management through the American Nurses Credentialing Center.
  • RN Licensure:Current, full, active, and unrestricted

 

 

Position contingent upon contact award. Incumbents encouraged to contact us.

Come join our team! 





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. Position contingent upon contract award. 

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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