Nursing Jobs - Registered Nurse - Utilization Management

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Registered Nurse - Utilization Management

This is an archived job. Please click here to see a list of current jobs in this specialty.
Job Information
Company: Loyal Source Government Services
Job Type Name: Nursing Jobs
Date Added: 2013-03-01
Date Updated: 2013-06-06
Job Title: Registered Nurse - Utilization Management
Job Description: Loyal Source Government Services is currently hiring multiple Registered Nurses - Utilization Management at Wright Patterson AFB near Dayton, OH.

To apply please email your resume to Kirk Moorman at [Register to View]

This opportunity offers an RN - Utilization Manager excellent stability, great compensation and benefits packages and a great work environment serving a patient population of active duty Air Force members and beneficiaries.

QUALIFICATIONS:

- Must have 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); computer applications/software to include Microsoft Office programs, MS Outlook (e-mail), and internet familiarity; 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; performing prospective, concurrent, and retrospective reviews to justify medical necessity for requested medical care and to aid in collection and recovery from multiple insurance carriers; inpatient unit rounds for clinical data collection; providing documentation for appeals or grievance resolution; applying critical thinking skills and expertise in resolving complicated healthcare, social, interpersonal and financial patient situations; applying problem-solving techniques to articulate medical requirements to patients, families/care givers, medical and non-medical staff in a professional and courteous way.
- 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.
- License. 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.
- Experience. A minimum of 3 years for ADN or 2 years for BSN full-time experience in utilization management/utilization review or in broad-based clinical nursing.
- Certification. Certified Professional in Healthcare Management (CPHM) by McKesson or a clinical specialty recognized by American Nurses Credentialing Center -OR- certification eligible with 3 years for ADN or 2 years for BSN experience in utilization management/utilization review or in broad-based clinical nursing.

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City: Dayton
State: Ohio
Job Details
Degree Required: RN
Position Type: Interested in all
Experience Required: 0-2 Years
Specialty: Nursing-General Jobs
Accept Visa Candidates: No
Additional Information:
Contact Details
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