Registered Nurse - Utilization Management
About The Position
Professional Performance Development Group (PPDG) is seeking a Registered Nurse - Utilization Management to support healthcare operations at Langley Air Force Base in Langley, Virginia. The role supports appropriate utilization of healthcare resources, coordinates patient care, assists with case management, and promotes quality outcomes for military beneficiaries. The nurse provides utilization management, care coordination, and case management support. In collaboration with physicians, nurses, case managers, and multidisciplinary healthcare teams, the role reviews healthcare services for medical necessity, resource utilization, quality outcomes, and continuity of care. The position supports the MTF Utilization Management plan/program as prescribed in the DoD Medical Management Guide and by the MTF Utilization Management Director. The schedule is Monday through Friday, 7:30 a.m. to 4:30 p.m. Candidates must be legally authorized to work in the United States and meet applicable contract requirements.
Requirements
- Associate Degree in Nursing.
- Graduation from a college or university accredited by the Accreditation Commission for Education in Nursing (ACEN) or the Commission on Collegiate Nursing Education (CCNE).
- Current, full, active, and unrestricted Registered Nurse license.
- Three years of experience within the last four years as a registered nurse in utilization management.
- Current Basic Life Support (BLS) certification.
- Legally authorized to work in the United States and able to meet applicable contract requirements.
- Knowledge of utilization management, case management, and care coordination practices.
- Strong clinical assessment and critical thinking skills.
- Knowledge of healthcare regulations, accreditation standards, and quality improvement methodologies.
- Ability to evaluate medical necessity and healthcare resource utilization.
- Effective communication and collaboration skills.
- Proficiency in electronic medical record systems and healthcare databases.
- Strong organizational and documentation skills.
Responsibilities
- Support 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 review medical cases to confirm appropriate care, monitor patterns and trends, and develop action plans for areas requiring improvement.
- Report utilization patterns and brief provider and executive staff.
- Maintain reports on cases denied or receiving reduced third-party payments and report provider profiles to MTF management for corrective action.
- Participate in multidisciplinary teams to resolve recurring problems in healthcare delivery for care within or outside the MTF, including referrals.
- Coordinate patient care and provide case management support to promote quality outcomes and continuity of care.
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What This Job Offers
Job Type
Full-time
Education Level
Associate degree
