Registered Nurse - Utilization Manager

Overview

ERP International is seeking a Registered Nurse - Utilization Managerfor a full-time position supporting Little Rock AFB, Arkansas.   Apply online today and discover more about this exceptional employment opportunity.  www.erpinternational.com

 

Be the Best!  Join our team of exceptional health care professionals across the nation. Come discover the immense pride and job satisfaction ERP Employees experience in providing care for our Military Members, their Families and Retired Military Veterans!  ERP International is honored to have been named one of The Washington Post's 2023 Top Workplaces!

* Excellent Compensation & Exceptional Comprehensive Benefits!* Paid Vacation, Paid Sick Time, Plus 11 Paid Federal Holidays! 

* Medical/Dental/Vision, STD/LTD/Life, Health Savings Account available, and more!* Annual CME Stipend and License/Certification Reimbursement!

* Matching 401K!

 

About ERP International, LLC: ERP is a nationally respected provider of health, science, and technology solutions supporting clients in the government and commercial sectors. We provide comprehensive enterprise information technology, strategic sourcing, and management solutions to DoD and federal civilian agencies in 40 states. Founded in 2006, ERP is headquartered in Laurel, MD and maintains satellite offices in Montgomery, AL and San Antonio, TX - plus project locations nationwide. ERP is an Equal Opportunity Employer - Disability and Veteran.

Responsibilities

Work Schedule:Work schedule shall be betwee 0700-1700 Monday-Friday to include a one-hour uncompensated meal break as determined by the clinical department.

 

Core Duties: The duties include, but are not limited to the following;

Coordinate patient care in collaboration with a wide array of healthcare professionals. Facilitate the achievement of optimal outcomes in relation to clinical care, quality, and cost effectiveness. Ensure compliance with standards of care and practice in accordance with all established policies, procedures, and guidelines used in the MTF. Develop and implement a comprehensive UM plan/program in accordance with the facility's goals and strategic objectives. Perform data/metrics collection on identified program areas; analyze and trend results, including over- and underutilization of healthcare resources. Identify areas for improvement and cost containment. Report utilization patterns and provide 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 prospective, concurrent, and/or retrospective utilization review to assess whether aspects of a patient's care is medically necessary and appropriately delivered for planned inpatient and outpatient surgeries. Communicate and collaborate with a diverse group of people for the purpose of informing the healthcare team of plans/actions, for teaching/education to benefit the patient/family and organization. Make referral appointments and arrange specialty care as appropriate. Conduct research in support of improved practice and patient outcomes.

Qualifications

Minimum Qualifications:

Degree:Possess a Bachelor's degree of Nursing. Education: Graduate from a college or university accredited by the Accreditation Commission for Education in Nursing (ACEN), the Commission on Collegiate Nursing Education (CCNE), or a national nursing accrediting agency recognized by the US Department of Education.

Experience:Possess a minimum experience of at least 2 years of full time total nursing experience in a direct patient care setting. Must have UM, utilization review or case management experience for 24 recent consecutive months

Must be knowledgeable in medical privacy and confidentiality (Health Insurance Portability and Accountability Act [HIPAA]); accreditation standards of Accreditation Association for Ambulatory Health Care (AAAHC), The Joint Commission (TJC), and Clinical Practice Guidelines (CPGs). Must have a working knowledge of Ambulatory Procedure Grouping (APGs), Diagnostic Related Grouping (DRGs), International Classification of Diseases- Current Version (ICD), and Current Procedural Terminology-Current Version (CPT) coding; and McKesson (InterQual) and/or Milliman Care Guidelines. Must be able to perform prospective, concurrent, and retrospective reviews to justify medical necessity for requested medical care and to aid in collection and recovery from multiple insurance carriers. Must be able to collect clinical data from inpatient and outpatient sources; provide documentation for appeals or grievance resolution; apply critical thinking skills and expertise in resolving complicated healthcare, social, interpersonal and financial patient situations; apply problem-solving techniques to articulate medical requirements to patients, families/care givers, medical and non-medical staff in a professional and courteous way.

* Certification:Certified/certification eligible in relevant specialty, such as Certified Managed Care Nurse through the American Board of Managed Care Nurses or Certified Informatics Nursing, Ambulatory Care Nursing, Medical-Surgical Nursing or Nursing Case Management through the American Nurses Credentialing Center.

Licensure:Current, full, active and unrestricted license as a Registered Nurse 

* Security: Must possess ability to pass a Government background check/security clearance.* Life Support Certification: Possess a current AHA OR ARC BLS Healthcare Provider certification.

Employment Type: OTHER