Talent.com
Registered Nurse (Utilization Review)

Registered Nurse (Utilization Review)

Giacare IncUSAF Academy, Colorado, United States, 80840
7 days ago
Job type
  • Full-time
Job description

GiaCare Inc., in anticipation of a future government contract award, is now accepting applications for experienced, civilian  Registered Nurses (Utilization Review Managers) to work alongside the federal government, in support of the Air Force Academy (Colorado Springs, Colorado).

Requirements :

Education :   Associates Degree of Nursing (ADN) OR Bachelor of Science in Nursing (BSN).  Graduate from a college or university accredited by Accreditation Commission for Education in Nursing (ACEN), the Commission on Collegiate Nursing Education (CCNE).

Certifications :   Basic Life Support (BLS) certification

Board Certification :    N / A

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

Experience :   One year as a Registered Nurse in Utilization Management.  Three additional years as Registered Nurse in any clinical setting.

Duties :

Serves as coordinator / liaison with provider, staff, and patient to ensure that actual healthcare received is appropriate to meet TRICARE beneficiaries’ healthcare needs. Work involves gathering information, identifying, and analyzing data, and developing recommendations to resolve problems related to the appropriate utilization of patient care services at the appropriate level of care. Qualitative and quantitative analytical techniques, such as prospective, concurrent and retrospective reviews are applied when conducting studies along with determining the effectiveness of healthcare provided with ongoing refinement of methods, techniques and processes when conducting analysis in Utilization Review. Employee uses judgement to choose to interpret or adapt available guidelines to individual situations and problems and writes local guidelines and polices as needed. This requires the individual to fully understand patient care standards, criteria, and guidelines used to develop and / or adapt current referral management methodologies to recognized inefficiencies, to make recommendations on clinical practices, and institutionalize referral management concepts and practices.

As a GiaCare Inc. employee, you may enjoy the following benefits :

  • Medical Insurance
  • Vision Insurance
  • Dental Insurance
  • Short-Term Disability Insurance
  • Life and AD&D Insurance
  • Paid Time Off (PTO)
  • 401k (non-matching)
  • Employee Referral Program
  • A wide variety of employee discounts
  • MUST BE US CITIZEN

Compensation details : 48.09-52.71 Yearly Salary

PIa78971d9958b-30511-38743881

Create a job alert for this search

Nurse Utilization Review • USAF Academy, Colorado, United States, 80840

Related jobs
  • Promoted
HEDIS Coding Quality Auditor

HEDIS Coding Quality Auditor

VirtualVocationsColorado Springs, Colorado, United States
Full-time
A company is looking for a Coding Quality Auditor, HEDIS.Key Responsibilities Conduct clinical quality audits and identify issues for quality improvement within the HEDIS project Collect and org...Show moreLast updated: 1 day ago
  • Promoted
Health Information Analyst

Health Information Analyst

VirtualVocationsColorado Springs, Colorado, United States
Full-time
A company is looking for a Health Information Discharge Analyst I.Key Responsibilities Reviews inpatient records to ensure completion of discharge summaries and identifies deficiencies Updates d...Show moreLast updated: 30+ days ago
  • Promoted
Licensed RN Clinical Appeals Reviewer

Licensed RN Clinical Appeals Reviewer

VirtualVocationsColorado Springs, Colorado, United States
Full-time
A company is looking for an IBR Clinical Appeals Reviewer who will analyze and respond to client and hospital claim review appeal inquiries. Key Responsibilities : Analyze scope and resolution of I...Show moreLast updated: 1 day ago
  • Promoted
Medical Device Quality Engineer

Medical Device Quality Engineer

VirtualVocationsColorado Springs, Colorado, United States
Full-time
A company is looking for a Senior Principal Software Quality Engineer.Key Responsibilities Provide Quality Engineering leadership for software and hardware product development teams, ensuring com...Show moreLast updated: 30+ days ago
  • Promoted
  • New!
HEOR Data Scientist

HEOR Data Scientist

VirtualVocationsColorado Springs, Colorado, United States
Full-time
A company is looking for a HEOR Data Scientist.Key Responsibilities Lead analytics for assigned therapeutic area, addressing analytical complexities Present analysis results and key findings to ...Show moreLast updated: 13 hours ago
  • Promoted
  • New!
State Licensed Clinical Coding Auditor

State Licensed Clinical Coding Auditor

VirtualVocationsColorado Springs, Colorado, United States
Full-time
Key Responsibilities Conduct MS-DRG and APR-DRG coding reviews to ensure accurate DRG assignment and identify overpayments Perform clinical coding reviews using ICD-10-CM / PCS guidelines and main...Show moreLast updated: 5 hours ago
  • Promoted
Behavioral Health Coding Auditor

Behavioral Health Coding Auditor

VirtualVocationsColorado Springs, Colorado, United States
Full-time
A company is looking for a Coding and Compliance Auditor-Behavioral Health.Key Responsibilities : Perform operational and financial audits of provider claims to identify overpayments and resolve r...Show moreLast updated: 1 day ago
  • Promoted
RN Clinical Appeals Reviewer

RN Clinical Appeals Reviewer

VirtualVocationsColorado Springs, Colorado, United States
Full-time
A company is looking for an IBR Clinical Appeals Reviewer - Remote.Key Responsibilities Analyze and respond to IBR Appeals inquiries Perform medical record reviews and prepare written appeals C...Show moreLast updated: 30+ days ago
  • Promoted
  • New!
LA Licensed Clinical Review Nurse

LA Licensed Clinical Review Nurse

VirtualVocationsColorado Springs, Colorado, United States
Full-time
A company is looking for a Clinical Review Nurse - Concurrent Review.Key Responsibilities Perform concurrent reviews to determine overall health and appropriate level of care for members Review ...Show moreLast updated: 11 hours ago
  • Promoted
Registered Nurse Quality Assurance

Registered Nurse Quality Assurance

VirtualVocationsColorado Springs, Colorado, United States
Full-time
A company is looking for a Quality Assurance Registered Nurse (Telehealth Support) - Full-Time.Key Responsibilities Lead and support quality improvement initiatives across clinical programs Iden...Show moreLast updated: 30+ days ago
  • Promoted
Healthcare Analytics Analyst

Healthcare Analytics Analyst

VirtualVocationsColorado Springs, Colorado, United States
Full-time
A company is looking for a Healthcare Analytics Analyst responsible for analyzing healthcare data and providing insights for cost containment and utilization. Key Responsibilities Develops and dis...Show moreLast updated: 30+ days ago
  • Promoted
  • New!
State Licensed Clinical Content Reviewer

State Licensed Clinical Content Reviewer

VirtualVocationsColorado Springs, Colorado, United States
Full-time
A company is looking for a Clinical Content Editor - PGY-1 / Medical Students.Key Responsibilities Collaborate with a multidisciplinary team to create and curate content on emerging medical technol...Show moreLast updated: 7 hours ago
  • Promoted
Database Engineer, Healthcare Compliance

Database Engineer, Healthcare Compliance

VirtualVocationsColorado Springs, Colorado, United States
Full-time
A company is looking for a DBA Engineer, Fabric.Key Responsibilities Own all database objects, including tables, views, and stored procedures Design and optimize datasets for Power BI reporting ...Show moreLast updated: 2 days ago
  • Promoted
South Carolina Licensed RN Reviewer

South Carolina Licensed RN Reviewer

VirtualVocationsColorado Springs, Colorado, United States
Full-time
A company is looking for an RN Medical Reviewer II to perform medical reviews and support medical claims processing.Key Responsibilities Conduct medical claim reviews for complex services and det...Show moreLast updated: 1 day ago
  • Promoted
Clinical Trial Assistant

Clinical Trial Assistant

VirtualVocationsColorado Springs, Colorado, United States
Full-time
A company is looking for a Clinical Trial Assistant (Remote & Full-Time).Key Responsibilities Maintain and manage the Trial Master File (TMF) for accuracy and inspection readiness Act as a prima...Show moreLast updated: 30+ days ago
  • Promoted
Health Information Management Specialist

Health Information Management Specialist

VirtualVocationsColorado Springs, Colorado, United States
Full-time
A company is looking for a HIM / RCM Product Specialist.Key Responsibilities Act as the primary HIM expert for the Products and Technology team and provide strategic input on AI-driven HIM solution...Show moreLast updated: 30+ days ago
  • Promoted
  • New!
Michigan Licensed Health Information Analyst

Michigan Licensed Health Information Analyst

VirtualVocationsColorado Springs, Colorado, United States
Full-time
A company is looking for a Health Information Management Analyst I - Document Imaging and QA.Key Responsibilities Perform quality assurance checks on imaged documents and ensure accurate indexing...Show moreLast updated: 7 hours ago
  • Promoted
Medical Reviewer Contractor

Medical Reviewer Contractor

VirtualVocationsColorado Springs, Colorado, United States
Full-time
A company is looking for a Medical Reviewer / Safety Reviewer III.Key Responsibilities Provide medical oversight for scientific review and approval of promotional and medical materials Collaborate...Show moreLast updated: 1 day ago
  • Promoted
Healthcare Implementation Analyst

Healthcare Implementation Analyst

VirtualVocationsColorado Springs, Colorado, United States
Full-time
A company is looking for an Implementation Business Analyst to create business requirements and liaise between Business Operations and Technology IT teams for new projects and improvements.Key Resp...Show moreLast updated: 1 day ago
  • Promoted
Infusion Coordinator

Infusion Coordinator

VirtualVocationsColorado Springs, Colorado, United States
Full-time
A company is looking for an Infusion Coordinator to join their team.Key Responsibilities Schedule infusions for GI patients and monitor infusion queues for timely appointments Interact with medi...Show moreLast updated: 30+ days ago