Utilization Management Registered Nurse

Spectrum Healthcare Resources•Cheyenne, WY

4d•$39 - $48

About The Position

Spectrum Healthcare Resources has an excellent opportunity for a civilian Utilization Management Registered Nurse at FE Warren Air Force Base in Cheyenne, WY. Full-time opportunity Monday - Friday (0700-1700) No weekends, on-call or holidays required Provide care and resources to military community Full complement of benefits to include health, dental and vision insurance, PTO, 11 Paid Holidays, 401(k) and more Pay range is $39-48/hour Company Overview: At Spectrum, we utilize over thirty-five years of experience providing optimal solutions for federal agencies that are both innovative and cost-effective. We hold ourselves to the highest standard to ensure successful outcomes for the facilities and health care professionals we serve. As a Joint Commission Certified Healthcare Resource, dependability and service are the driving forces of our mission. EOE/Disabled/Veterans

Requirements

BSN Degree
6 years of clinical nursing experience and 1 year of utilization management experience required
Knowledge, skills and computer literacy to interpret and apply medical care criteria, such as InterQual or Milliman Ambulatory Care Guidelines.
Experience in performing prospective, concurrent, and retrospective reviews to justify medical necessity for medical care to aid in collection and recovery from multiple insurance carriers.
Current RN license in Wyoming

Responsibilities

Monitor specialty care referrals for appropriateness, covered benefit, and authorized surgery/medical procedures, laboratory, radiology, pharmacy, and general hospital procedures and regulations to analyze medical referrals/appointments.
Receives and makes patient telephone calls and computer/written correspondence regarding specialty clinic appointments and referrals.
Develops and implements a comprehensive Utilization Management plan/program for beneficiaries within MTF’s goals and objectives.