Registered Nurse - Utilization Management

Registered Nurse – Utilization Management Location: Langley AFB, VA Make a Difference in Military Healthcare Professional Performance Development Group (PPDG) is seeking a dedicated Registered Nurse

• Utilization Management to support healthcare operations at Langley Air Force Base . This position plays a critical role in ensuring appropriate utilization of healthcare resources, coordinating patient care, supporting case management activities, and promoting quality healthcare outcomes for military beneficiaries. Based on the Registered Nurse and Registered Nurse Case Manager minimum qualifications and core duties identified Position Summary The Registered Nurse
• Utilization Management provides utilization management, care coordination, and case management support services. Working collaboratively with physicians, nurses, case managers, and multidisciplinary healthcare teams, the RN reviews healthcare services for medical necessity, resource utilization, quality outcomes, and continuity of care.

Minimum Qualifications

Education

Associate Degree in Nursing. Graduate from a college or university accredited by the Accreditation Commission for Education in Nursing (ACEN) or the Commission on Collegiate Nursing Education (CCNE). Licensure Current, full, active, and unrestricted Registered Nurse license. Experience Experience: Current experience required is three years within the last four years as a registered nurse in utilization management.

Required Certifications Current Basic Life Support (BLS) certification. Work Authorization Candidates must be legally authorized to work in the United States and meet applicable contract requirements.

Essential Duties and Responsibilities

Supports 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 reviews medical cases to confirm receipt of appropriate care, monitor for patterns/trends and develop action plan for areas requiring improvement.

Reports on utilization patterns; briefs provider staff and executive staff. Maintains reports on which cases have been denied or received reduced third party payments and reports provider profiles to the MTF management for corrective action. Participates on multi-disciplinary teams to resolve recurring problems in the healthcare delivery process for care within or outside the MTF including referrals Knowledge, Skills, and Abilities 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. Monday-Friday 7:30AM-4:30PM