Registered Nurse (RN) - Utilization Management

Spectrum Healthcare Resources•, TX

5d•Onsite

About The Position

Spectrum Healthcare Resources has a potential opportunity for a Registered Nurse Utilization Management at Lackland AFB in San Antonio, TX. This contract position offers a Monday-Friday schedule from 7:30 am to 4:30 pm in an outpatient clinic setting. The role involves no nights, weekends, or holidays, and no on-call duties, serving a stable patient population. Benefits include paid time off, paid holidays, and a comprehensive benefits package including Medical, Dental, Vision, and 401(k).

Requirements

Associate Degree of Nursing.
Must possess a bachelor's degree in relevant health sciences or health informatics from an accredited university.
Graduate from a college or university accredited by the ACEN or CCNE.
Active RN license in any state.
2+ years of clinical and utilization management RN experience.
Basic Life Support Certification from American Heart.

Responsibilities

Supports a comprehensive MTF Utilization Management plan/program as prescribed in the DoD Medical Management Guide and by the MTF Utilization Management Director.
Actively and retrospectively reviews medical cases to confirm receipt of appropriate care, monitor for patterns/trends and develop action plan for areas requiring improvement.
Reports on utilization patterns; briefs provider staff and executive staff.
Maintains reports on which cases have been denied or received reduced third party payments and reports provider profiles to the MTF management for corrective action.
Participates on multi-disciplinary teams to resolve recurring problems in the healthcare delivery process for care within or outside the MTF including referrals.
Investigate and resolve queries from MTF clinics by analyzing reports and data.
Provide education and guidance on reporting systems and tools to ensure effective utilization by clinic staff.