Spectrum Healthcare Resources has an excellent opportunity for a Registered Nurse Utilization Manager (RNUM).
This is a remote position, working entirely from the nurse’s home. The nurse will be reviewing cases, educating patients on appropriate care and managing health care costs for the dependents of our Nation’s Active Duty and eligible retirees.
Schedule: Monday through Friday, 8-5PM PST
Responsibilities:
- Reviews and makes decisions about the appropriateness and level of beneficiary care being provided in an effort to provide cost effective care and ensure proper utilization of resources.
- Applies clinical knowledge to make determinations for pre-authorization, inpatient and continued stay reviews for Medical /Surgical and/or Behavioral Health requests to establish medical necessity, benefit coverage, appropriateness of quality of care, and length of stay or care plan.
- Utilizes clinical criteria and policy keys to complete review.
- Documents in the medical management information system.
- Prepares and presents more complex cases for Medical Director Review.
- Refer cases to Case Management and Disease Management as appropriate.
- Advises non-clinical staff on clinical and coding questions.
- Conducts pre-admission screening and assessments
Requirements:
- ADN or BSN degree required
- Active RN license in any state
- Must be able to receive a favorable Interim and adjudicated final Department of Defense (DoD) background investigation OR have a current active security clearance/DoD clearance (preferred)
- Worked previously with Healthnet Federal Services or Tricare
- 2+ years of clinical and utilization management RN experience
- Willing to work PST/MST/CST
Company Overview:
Spectrum Healthcare Resources (SHR) was established in 1988 to deliver systems and processes designed to meet the unique needs of Military and VA Health Systems. SHR is a leading organization that provides physician and clinical staffing and management services to United States Military Treatment Facilities, VA clinics and other Federal Agencies through various contracting vehicles. A Joint Commission Health Care Staffing Services firm, SHR is the military staffing division of TeamHealth, a Nationwide organization that serves 850 civilian and military hospitals with a team of 9,600 affiliated health care professionals. EOE/Disabled/Veterans
