FSR (Federal Staffing Resources)
  • Misawa, Aomori, JPN
  • Full Time

 

Registered Nurse (RN) - Utilization Manager job in Misawa, Japan. 

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

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

  • Monday-Friday
  • Days only
  • Holidays off
  • Full-time hours
  • Paid holidays
  • Competitive Employment Package

 

Registered Nurse (RN) - Utilization Manager  Job Overview:

  • Work in collaboration with PCMH teams, case managers (CM), disease management (DM) nurses, special needs coordinator (SNC), health care integrator (HCI) and group practice manager (GPM) to determine measures to target and manage enrollees and/or processes that relate to high-cost, high-volume or problem-prone diagnoses, procedures, services and beneficiaries who have demonstrated high utilization rates.  
  • Makes appropriate recommendations to DMs and CMs for high-utilization or high-risk enrollees to be entered into their processes.
  • Conduct special analyses on patient utilization of health services and health care provider orders and referrals for specialty care, therapies, pharmaceuticals and diagnostic testing to identify both excessive and insufficient use of services (e.g., patients with 100% or more emergency room visits compared to the average of all patients; physicians who order 50% more special tests than their peers). 
  • Identifies ways to reduce overutilization and suboptimal underutilization of services.
  • Facilitate utilization management activities by participation in multidisciplinary patient care activities. 
  • Initiate/coordinate communication between beneficiaries, PCMH team, DoD/civilian providers and ancillary health care workers. 
  • Report any identified quality of care issues to SGH and/or Quality Management officer IAW MTF policy.
  • Perform medical in-processing utilization reviews for newly in-processed beneficiaries for covered benefits and specific needs and document the review on the patient's electronic health record.
  • Refer complex care findings to CM, DM or SNC.
  • Track and report medical waiver discrepancies and patient safety issues to the HCI.
  • Develop annual Utilization Management plan for inclusion in Population Health/Medical Management Strategic Plan in collaboration with stakeholders.
  • Provide Referral Management Center (RMC) supervision.
  • Submitting referrals from civilian providers to the TRICARE Service Center or TSC for medical necessity and appropriateness review.
  • At the population health management level, the UM shallcoordinate with specialty referral clinics in obtaining pre-appointment instructions and/or tests for certain patient diagnostic groups.

 

Registered Nurse (RN) - Utilization Manager  Job Qualifications:

  • BLS
  • Bachelor of  Science in Nursing (BSN) 
  • Graduate from a college or university accredited by NLNAC or CCNE 
  • RN License: active, unrestricted, and current. Any U.S. state license. 
  • One year of nursing experience
  • Utilization Management, Outpatient, or ambulatory care nursing - preferred

 

 

 

 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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