Registered Nurse- Utilization MgtElite Staffing Network LLC • Shreveport, Louisiana, United States
Registered Nurse- Utilization Mgt
Elite Staffing Network LLC • Shreveport, Louisiana, United States
30+ days ago
Job type
- Full-time
- Quick Apply
Job descriptionAssist with orientation and training of other Medical Management staff and assist inproviding, assessing, and improving a wide variety of customer service relations. AssistsMTF officials to ensure Unit Effectiveness Inspection standards are met at the operationallevel. Assists in the development and implementation of a comprehensive UtilizationManagement plan / program for beneficiaries within MTF’s goals and objectives. Thisplan is based on using the 12-step approach as described in the DoD MedicalManagement Guide. Establish procedures for conducting reviews, including identification of types ofhealthcare services for which preauthorization or concurrent review will be required.Reviews previous and present medical care practices as needed for patterns, trends, orincidents of under or over utilization of hospital resources incidental to medical careprovided to beneficiaries. Plans and performs reviews IAW established indicators and guidelines to providequality cost-effective care. Ensures identified patient needs are addressed promptly withappropriate decisions. Provides timely, descriptive feedback regarding utilization reviewissues. Use the same generally accepted standards, norms, and criteria to review thequality, completeness, and adequacy of healthcare provided within the MTF, as well asits necessity, appropriateness, and reasonableness. Adhere to the established standardized DCS appeal process for resolvingbeneficiaries’ request for reconsideration of MTF denials of care based on medical necessity determinations in accordance with References (e) and (o). After following the directed methodology for appeals, the MTF will also adhere to its respective Service or joint commands’ process for intermediate notification, if any, prior to progressing from the internal to external level of appeals. Adhere to the MHS and Military Department’s or Joint Medical Commands’ referral management policies to manage internal and external referrals. Incorporate UM strategies as part of the referral management center’s routine processes. Ensure processes monitor, manage, and optimize demand or capacity (access). Collaborate with the PCMH team to develop performance measures and processes for clinically important conditions, as determined by the PCMH teams and MTF leadership. These clinically important conditions should include but may not be limited to high -cost, high-volume, or problem-prone diagnoses, procedures, services, and beneficiaries that utilize healthcare at higher rates than average and who may benefit from intervention and more intense care coordination. Performs data / metric collection. Analyzes data and prepares reports to describe resource utilization patterns. Briefs applicable data / slides to provider staff, executive staff, newcomers, as appropriate. Identifies areas requiring intensive management or areas for improvement. 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. Serves as a liaison with higher headquarters, TRICARE Regional Office, MTF national accreditation organization, professional organizations, and community health care facilities concerning Utilization Management. Participates in in-services and continuing education programs. Briefs applicable data / slides to provider staff, executive staff, newcomers, as appropriate. Establishes and maintains good interpersonal relationships with co-workers, families, peers, and other health team members. Submits all concerns through Utilization Management Director; be able to identify, analyze and make recommendations to resolve problems and situations regarding referrals. Ensure coordination and communication among all MM staff, including clinical and business personnel, to assure efficient, effective, quality care and services. Be productive and perform with minimal oversight and direction. Be able to independently identify, plan, and carry out projects with consideration for the goals and objectives of the TRICARE Utilization Management Element. Develops detailed procedures and guidelines to supplement established administrative regulations and program guidance. Recommendations are based upon analysis of work observations, review of procedures, and application of guidelines. Education : Minimum ASN from an accredited college or university Experience : One year of experience in Utilization Management is required. Full time employment as a registered nurse within the last 36 months is mandatory. Six years of clinical nursing experience is preferred. Licensure : Current, full, active, and unrestricted RN license from any state. Life Support Certifications : AHA or ARC BLS Certification Security : Must possess ability to pass a Government background check / security clearance.
Elite Staffing Network is seeking a Utilization Management Registered Nurse (RN) for a full-time position supporting the 2d Medical Group, Barksdale AFB, LA.
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!
Schedule :
Monday - Friday, 9 hours between 7 : 00am and 5 : 00pm, with a one-hour lunch
No Weekends or Holidays
Duties : The duties include, but are not limited to the following;
Minimum Qualifications :
Must possess experience in performing prospective, concurrent, and retrospectivereviews to justify medical necessity for medical care to aid in collection and recoveryfrom multiple insurance carriers. Review process includes Direct Care and Purchase CareSystem referrals, ward rounds for clinical data collection, contacting providers to informthem of dollars lost for missing documentation, and providing documentation for appealsresolution. Possesses working knowledge of Ambulatory Procedure Grouping (APGs),Diagnostic Related Grouping (DRGs), International Classification of Diseases-Version 9(ICD), and Current Procedural Terminology-Version 4 (CPT-4) coding.
Create a job alert for this search
Registered Nurse • Shreveport, Louisiana, United States
Related jobs
The competent Nurse, in the same or similar clinical setting, practices independently and demonstrates an awareness of all relevant aspects of a situation.
Provides routine and complex care, with th...Show more
A company is looking for a Director of Utilization Management Authorization and Claims.Key Responsibilities Directs the utilization management team to ensure compliance with policies and procedur...Show more A company is looking for a Utilization Management Nurse Consultant - Work From Home.Key Responsibilities Utilizes clinical experience to assess, plan, implement, coordinate, monitor, and evaluate...Show more 
The competent Nurse, in the same or similar clinical setting, practices independently and demonstrates an awareness of all relevant aspects of a situation.
Provides routine and complex care, with th...Show more
The competent Nurse, in the same or similar clinical setting, practices independently and demonstrates an awareness of all relevant aspects of a situation.
Provides routine and complex care, with th...Show more
Description Summary : The competent Nurse, in the same or similar clinical setting, practices independently and demonstrates an awareness of all relevant aspects of a situation.Provides routine and ...Show more
The competent Nurse, in the same or similar clinical setting, practices independently and demonstrates an awareness of all relevant aspects of a situation.
Provides routine and complex care, with th...Show more Provides professional nursing care for the comfort and well-being of patients.Prepares equipment and assists physician during examinations and treatments.
Administers prescribed medications, changes...Show more The competent Nurse, in the same or similar clinical setting, practices independently and demonstrates an awareness of all relevant aspects of a situation.
Provides routine and complex care, with th...Show more A company is looking for a Manager, Utilization Management (Remote).Key Responsibilities Manage a team of UM Nurse Analysts, guiding workload and supporting team development Partner with leaders...Show more A company is looking for a Utilization Review Nurse- RN.Key Responsibilities Conduct assessments and reviews for medical necessity of treatment requests and plans Process appeals for non-certifi...Show more The competent Nurse, in the same or similar clinical setting, practices independently and demonstrates an awareness of all relevant aspects of a situation.
Provides routine and complex care, with th...Show more The competent Nurse, in the same or similar clinical setting, practices independently and demonstrates an awareness of all relevant aspects of a situation.
Provides routine and complex care, with th...Show more 
A professional who utilizes the nursing process to assess, implement, coordinate, and evaluate patient care activities.Collaborate with other Clinical Associates and Healthcare disciplines to meet ...Show more A company is looking for a Utilization Nurse Reviewer (Remote).Key Responsibilities Conduct timely clinical chart reviews and communicate effectively with third-party payers Review admission ser...Show more The competent Nurse, in the same or similar clinical setting, practices independently and demonstrates an awareness of all relevant aspects of a situation.
Provides routine and complex care, with th...Show more 
Ensure you read the information regarding this opportunity thoroughly before making an application.The competent Nurse, in the same or similar clinical setting, practices independently and demonstr...Show more
We are seeking a Registered Nurse-Intensive Care Unit for a travel assignment in Salem Virginia.Show more
Registered Nurse-Acute MedSurgical A-Full Time
CHRISTUS Health • Bossier City, LA, US
Full-time
Last updated: 30+ days ago • Promoted
Registered Nurse Utilization Management
VirtualVocations • Shreveport, Louisiana, United States
Full-time
Last updated: 30+ days ago • Promoted
Compact RN Utilization Management Nurse
VirtualVocations • Shreveport, Louisiana, United States
Full-time
Last updated: 30+ days ago • Promoted
Registered Nurse-Acute Medsurgical A-Full Time (Bossier City)
Christus Health • Bossier City, LA, United States
Full-time
Last updated: 28 days ago • Promoted
Registered Nurse-Acute MedSurgical A-Full Time
Christus Health • Lakeview, Louisiana, United States
Full-time
Last updated: 30+ days ago • Promoted
Registered Nurse-Acute Medsurgical A-Full Time (Bossier City)
CHRISTUS Health • Bossier City, LA, US
Full-time
Last updated: 1 day ago • Promoted
Registered Nurse-Acute MedSurgical A-PRN
CHRISTUS Health • Frierson, Louisiana, United States
Full-time
Last updated: 30+ days ago • Promoted
Registered Nurse Float I-Nursing Float Pool-PRN
CHRISTUS Health • Bethany, Louisiana, United States
Full-time
Last updated: 30+ days ago • Promoted
Registered Nurse-Acute MedSurical A-Full Time
CHRISTUS Health • Shreveport, LA, US
Full-time
Last updated: 30+ days ago • Promoted
Registered Nurse Utilization Manager
VirtualVocations • Shreveport, Louisiana, United States
Full-time
Last updated: 30+ days ago • Promoted
Utilization Review Nurse - RN
VirtualVocations • Shreveport, Louisiana, United States
Full-time
Last updated: 1 day ago • Promoted
Registered Nurse-Cardiology Cath-PRN
CHRISTUS Health • Greenwood, Louisiana, United States
Full-time
Last updated: 30+ days ago • Promoted
Registered Nurse-Surg General-PRN
CHRISTUS Health • Frierson, Louisiana, United States
Full-time
Last updated: 30+ days ago • Promoted
Registered Nurse-Acute Medsurgical A-Full Time
Christus Health • Bossier City, LA, USA
Full-time
Last updated: 30+ days ago • Promoted
DC Licensed Utilization Nurse Reviewer
VirtualVocations • Shreveport, Louisiana, United States
Full-time
Last updated: 2 days ago • Promoted
RN, Registered Nurse - Villages Surgery Center
CHRISTUS Health • Blanchard, Louisiana, United States
Full-time
Last updated: 30+ days ago • Promoted
Registered Nurse-Acute MedSurical A-Full Time
Christus Health • Princeton, Louisiana, US
Full-time +1
Last updated: 30+ days ago • Promoted
Registered Nurse Intensive Care Unit
TotalMed • Shreveport, LA, USA
Full-time
Last updated: 30+ days ago • Promoted