Job description

IMMEDIATE OPENING for a full-time Registered Nurse (Utilization Management) to support the Joint Base Charleston, located in South Carolina.

Responsibilities and duties but not limited to:

Provides Utilization Management activities and functions by using MTF-specific Quality Improvement processes to identify areas for review from data, suspected problem areas, and input from departments/services within the facility. Prioritizes accordingly based on high dollar, high volume or problem prone diagnoses. Identifies gaps between desired and actual program outcomes and develops an action plan to fix gaps. Determines effectiveness of the plan and continually evaluates the impact of implementation. Incorporates applicable utilization review tasks to ensure patients receive the right care, at the right time, in the right place, with the right provider, at the right cost. Collaborates with staff, facility departments, and outside agencies to determine the best, most cost-efficient care.

Qualifications:

Degree/Education: Shall be a graduate from an associate (ADN) or baccalaureate degree (BSN) program in nursing accredited by a national nursing accrediting agency recognized by the US Department of Education.

Certifications in addition to Basic Life Support: Certified 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

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

• 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 have experience in Patient Advocacy, Patient Privacy, and Customer Relations.
• 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

Licensure/Registration: Maintain an active, valid, current, and unrestricted license (with no limitations, stipulations or pending adverse actions) to practice nursing as a registered nurse in any US state/jurisdiction.

Benefits include:

· Relocation Assistance (if needed)

· Paid Federal Holidays

· Paid Personal Leave Days

· Sick Days

· Health & Welfare Reimbursement

· 401(K)

Please email resume for immediate consideration

Job Type: Full-time

Pay: From $1.00 per hour

Benefits:

• 401(k)
• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Work Location: In person

colinoncars.com is the go-to platform for job seekers looking for the best job postings from around the web. With a focus on quality, the platform guarantees that all job postings are from reliable sources and are up-to-date. It also offers a variety of tools to help users find the perfect job for them, such as searching by location and filtering by industry. Furthermore, colinoncars.com provides helpful resources like resume tips and career advice to give job seekers an edge in their search. With its commitment to quality and user-friendliness, colinoncars.com is the ideal place to find your next job.