Registered Nurse Utilization Manager

Company:

General Information
US-AK-Anchorage
N/A
2 Year Degree
Full-Time
At least 3 year(s)
None
False
False
Job Description

Civilian opportunity for a Registered Nurse Utilization Manager to provide full-time, clinical services at the U.S. military treatment facility at Hickam Air Force Base in Honolulu, HI. Clinic hours are Mondays to Fridays, 7:30am to 4:30pm.

We offer relocation assistance.

Please submit your resume to Rochelle Hicks to [Click Here to Email Your Resumé].

Job Requirements Qualifications:

1. Must have knowledge of medical privacy and confidentiality (Health Insurance Portability and Accountability Act [HIPAA]), and accreditation standards of Accreditation Association for Ambulatory Health Care (AAAHC), The Joint Commission (TJC), and Clinical Practice Guidelines (CPGs).

2. Must have a working knowledge of computer applications/software to include Microsoft Office programs, MS Outlook (e-mail) and internet familiarity.

3. 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.

4. Must have experience in Patient Advocacy, Patient Privacy, and Customer Relations.

5. 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.

6. 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/caregivers, medical and non-medical staff in a professional and courteous way.

7. Experience. Must have at least 36 months of total nursing experience in a direct patient care clinical setting. Must have utilization management, utilization review or case management experience for 24 recent consecutive months.

8. 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.