Utilization Management Nurse Carson

Location:

FORT CARSON, CO 80913 US (Primary)

Job Type: Full-time

Responsible for assuring the receipt of high quality, cost efficient medical outcomes for those enrollees identified as having the need for inpatient/outpatient precertification.

• Review precertification requests for medical necessity, referring to the Medical Director those that require additional expertise.
• Review clinical information for concurrent reviews.
• As part of the UMRN program, conduct ongoing availability, monitoring and oversight of non-clinical staff activities.
• Establish effective rapport with other employees, professional support service staff, customers, clients, patients, families, and physicians.
• Advocate quality care and enhanced quality of life.
• Advocate decreased hospital stay when appropriate.
• Maintain accurate records of all patient related interactions.
• Maintain regular and punctual attendance.
• Perform other duties as assigned.

None.

• Bachelor of Science in Nursing (BSN) is required.
• Minimum of two (2) years of prior experience in Utilization Management.
• Must possess a current, active, full, and unrestricted Registered Nurses (RN) licensed in Colorado, be able to practice using a nurse compact state license or have a license from any United States jurisdiction (with no limitations, stipulations or pending adverse actions).
• 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).
• Must have knowledge and experience, or demonstrate comprehension during training, with software and databases currently employed at the MTF (e.g., Microsoft Office, Access, Excel, and PowerPoint;
  Composite Health Care System [CHCS], Armed Forces Health Longitudinal Technological Application [AHLTA]).
• 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 (Inter Qual) and/or Milliman Care Guidelines.
• Life Support
  
  Certifications:
  
  Must possess and maintain current Healthcare Provider Basic Life Support (BLS). This Certification must be current at all times, at no additional expense to the government.
• Must obtain and maintain the site's required health screening and immunization requirements.
• Must obtain and maintain all required documents, certifications, licenses, etc. listed on the credentialling checklist, sent by Katmai’s Credentialing Specialist, for this position for initial hire.
• Must obtain and maintain any necessary security access and/or background checks.

• Certification by a Utilization Management-specific program such as Certified Professional in Healthcare Management (CPHM) is desired.
• Working knowledge of computer applications/software to include Microsoft Office programs, MS Outlook (e‑mail), and internet familiarity is required. The ability to input, extract, and format data from established databases is desired.
• Ability to effectively read, write and speak English in order to communicate with all patients and other healthcare providers.
• Ability to effectively communicate and collaborate with a diverse group of people for the purpose of informing the healthcare team of plans/actions, for teaching/education to benefit the patient/family and organization.
• Effectively uses appropriate communication format in addressing professional issues.
• Excellent written communication skills to perform accurate documentation, both written and electronic, of all activity in accordance with requirements.
• Must demonstrate ability to apply critical thinking skills and expertise in resolving complicated healthcare, social, interpersonal, and financial patient situations.

Full-time. May be required to work additional hours as needed to complete assignment or project.

All Market contractors are subject to working at a duty…