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Registered Nurse (RN) - Utilization Management

Location: Belleville
Posted on: October 8, 2018

Job Description:

Case Management opening in Belleville, Illinois. This and other rn jobs brought to you by Registered Nurse RN) - Utilization Management job in Belleville, Illinois. The Registered Nurse (RN) - Utilization Management job is within the military medical system and is a civilian position. Civilian and military personnel work together in the extensive military medical system. The hospitals and medical clinics provide services to the active duty military service members, military retirees, and their families and provide a full range of medical services. Our employees are our best assets! Come join our team of healthcare professionals where you are valued.Monday-FridayDays only!Fantastic PTO accrual rateCompetitive CompensationBenefit Package (health, dental, and vision plans)Dedication Program Manager to support your employment Registered Nurse (RN) - Utilization Management Job Overview:Inpatient:

  • Develops and implements a comprehensive Utilization Management plan/program in accordance with the facility's goals and strategic objectives.
  • Performs data/metrics collection on identified program areas; analyzes and trends results, including over- and underutilization of healthcare resources. Identifies areas for improvement and cost containment. Reports utilization patterns and provides feedback in a timely manner.
  • Analyzes medical referrals/appointments and general hospital procedures and regulations by monitoring specialty care referrals for appropriateness, covered benefits, and authorized surgery/medical procedures, laboratory, radiology and pharmacy.
  • Performs medical necessity review for planned inpatient and outpatient surgery; and performs concurrent review to include length of stay (LOS) for the facility's inpatients using appropriate criteria.
  • Reviews previous and present medical care practices for patterns; trends incidents of under-or over-utilization of resources incidental to providing medical care.
  • Gather necessary information, determine the medical necessity of services ordered or rendered, and determine appropriateness of certain levels of care IAW approved decision support tool.
  • Improvement initiatives. Promote and contribute quality performance, performance improvement programs, and nursing practice in a setting that supports professional practice and sets a positive exampleOutpatient:
    • Acts as referral approval authority for designated referrals per local/AF/DoD/national guidance and standards.
    • Verifies eligibility of beneficiaries
    • Obtains pertinent information from patients/callers and updates data in CHCS, AHLTA, local referral database, and other office automation software programs as appropriate and directed.
    • Ensures and monitors specialty care referrals for appropriateness, medical necessity, and if the appointment, diagnostic testing, or procedure requested is a covered benefit according to appropriate health plan.
    • Receives and makes patient telephone calls, written, or e-mail correspondence regarding specialty clinic appointments and referrals following MTF-specific processes.
    • Routinely monitors referral management Composite Health Care System (CHCS) queue to ensure patients referrals are appointed Registered Nurse (RN) - Utilization Management Job Qualifications:
      • BLS
      • Associates Degree of Nursing
      • Graduate from a NLNAC or CCNE accrediated college or university
      • RN Licensure: Current, full, active, and unrestricted. Any U.S. state.
      • Certified/certification eligible in relevant specialty, such as Certified Managed Care Nurse, Certified Informatics Nursing, Ambulatory Care Nursing, Medical-Surgical Nursing or Nursing Case Management.
      • Clinical competency within the past two years
      • Computer competency Position contingent on contract award. Incumbents HIGHLY encourage to contact us! Come join our team of healthcare professionals! Keyphrases: medical case management jobs, case manager jobs, case manager consultant jobs, case management consultant jobs, geriatric case management jobs, case management nursing jobs, nurse case manager jobs

        Keywords: FEDERAL STAFFING RESOURCES, Belleville , Registered Nurse (RN) - Utilization Management, Executive , Belleville, Illinois

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