RN - Utilization Manager

ID
2024-22651
Category
Registered Nurse specialties - Case Manager
Facility
DOD / MTF - New Mexico - Cannon Air Force Base

Job Description

CANNON AFB Banner

 

Spectrum Healthcare Resources is excited to offer a potential career opportunity for an Utilization Manager Registered Nurse at the Cannon Air Force Base. This civilian position is an outstanding chance to contribute to the health and well-being of our military members while enjoying a rewarding work-life balance and a supportive patient community. 

 

Join us in making a significant impact on the lives of those who serve our country, with a focus on quality care and professional development!

 

Requirements:

  • Bachelor of Science in Nursing from an accredited program.
  • Active, full, and unrestricted Registered Nurse license in the United States.
  • 6 years of clinical nursing experience.
  • 1 year of experience in Utilization Management or a similar role.
  • Proficient in applying medical criteria like InterQual or Milliman guidelines.
  • Knowledgeable in medical coding systems (APGs, DRGs, ICD-9, CPT-4).
  • Strong communication, interpersonal, and computer skills.

Job Responsibilities:

  • Handle Right of First Refusal (ROFR) requests promptly.
  • Manage and screen specialty care referrals ensuring they meet Cannon AFB's criteria.
  • Ensure all referral activities align with Cannon AFB's business rules and healthcare standards.
  • Keep up-to-date records such as the Specialty Clinic Booking Guidance, MTF Capabilities Report, and ROFR Reports for Cannon AFB.
  • Track, document, and follow up on referrals using Cannon AFB's designated systems.
  • Perform reviews to determine medical necessity, pre-authorizations, and handle medical appeals.
  • Aid in the recovery of funds from insurance carriers for services provided at Cannon AFB.
  • Utilize systems like CHCS, AHLTA, MHS GENESIS, or others as specified by Cannon AFB for managing referrals.
  • Ensure all data entries are precise and timely.
  • Collaborate with Cannon AFB's executive staff, clinical operations, resource management, medical records, and quality division to ensure efficient resource use and cost management for beneficiaries.
  • Train other Referral Management Center staff at Cannon AFB.

 

Company Overview:

 

At Spectrum, we leverage over thirty-five years of experience to deliver innovative and cost-effective solutions for federal agencies. Certified by the Joint Commission, we are committed to the highest standards of service and reliability.

 

EOE/Disabled/Veterans

Location : Location

US-NM-Clovis

Recruiter : Full Name: First Last

Gracie Barstad

Direct phone number

314-744-4133

Recruiter : Email

gracie_barstad@spectrumhealth.com

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