RN - Utilization Manager with Security Clearance
Apply NowCompany: Spectrum Healthcare Resources
Location: Clovis, NM 88101
Description:
Job Description Spectrum Healthcare Resources is excited to offer a potential career opportunity for an Utilization Manager Registered Nurse at the Cannon Air Force Base. This civilian position is an outstanding chance to contribute to the health and well-being of our military members while enjoying a rewarding work-life balance and a supportive patient community. Join us in making a significant impact on the lives of those who serve our country, with a focus on quality care and professional development! Requirements: * Bachelor of Science in Nursing from an accredited program.
* Active, full, and unrestricted Registered Nurse license in the United States.
* 6 years of clinical nursing experience.
* 1 year of experience in Utilization Management or a similar role.
* Proficient in applying medical criteria like InterQual or Milliman guidelines.
* Knowledgeable in medical coding systems (APGs, DRGs, ICD-9, CPT-4).
* Strong communication, interpersonal, and computer skills. Job Responsibilities: * Handle Right of First Refusal (ROFR) requests promptly. * Manage and screen specialty care referrals ensuring they meet Cannon AFB's criteria. * Ensure all referral activities align with Cannon AFB's business rules and healthcare standards. * Keep up-to-date records such as the Specialty Clinic Booking Guidance, MTF Capabilities Report, and ROFR Reports for Cannon AFB. * Track, document, and follow up on referrals using Cannon AFB's designated systems. * Perform reviews to determine medical necessity, pre-authorizations, and handle medical appeals. * Aid in the recovery of funds from insurance carriers for services provided at Cannon AFB. * Utilize systems like CHCS, AHLTA, MHS GENESIS, or others as specified by Cannon AFB for managing referrals. * Ensure all data entries are precise and timely. * Collaborate with Cannon AFB's executive staff, clinical operations, resource management, medical records, and quality division to ensure efficient resource use and cost management for beneficiaries. * Train other Referral Management Center staff at Cannon AFB. Company Overview: At Spectrum, we leverage over thirty-five years of experience to deliver innovative and cost-effective solutions for federal agencies. Certified by the Joint Commission, we are committed to the highest standards of service and reliability. EOE/Disabled/Veterans Location : Location US-NM-Clovis Recruiter : Full Name: First Last Gracie Barstad Direct phone number 314-744-4133 Recruiter : Email
* Active, full, and unrestricted Registered Nurse license in the United States.
* 6 years of clinical nursing experience.
* 1 year of experience in Utilization Management or a similar role.
* Proficient in applying medical criteria like InterQual or Milliman guidelines.
* Knowledgeable in medical coding systems (APGs, DRGs, ICD-9, CPT-4).
* Strong communication, interpersonal, and computer skills. Job Responsibilities: * Handle Right of First Refusal (ROFR) requests promptly. * Manage and screen specialty care referrals ensuring they meet Cannon AFB's criteria. * Ensure all referral activities align with Cannon AFB's business rules and healthcare standards. * Keep up-to-date records such as the Specialty Clinic Booking Guidance, MTF Capabilities Report, and ROFR Reports for Cannon AFB. * Track, document, and follow up on referrals using Cannon AFB's designated systems. * Perform reviews to determine medical necessity, pre-authorizations, and handle medical appeals. * Aid in the recovery of funds from insurance carriers for services provided at Cannon AFB. * Utilize systems like CHCS, AHLTA, MHS GENESIS, or others as specified by Cannon AFB for managing referrals. * Ensure all data entries are precise and timely. * Collaborate with Cannon AFB's executive staff, clinical operations, resource management, medical records, and quality division to ensure efficient resource use and cost management for beneficiaries. * Train other Referral Management Center staff at Cannon AFB. Company Overview: At Spectrum, we leverage over thirty-five years of experience to deliver innovative and cost-effective solutions for federal agencies. Certified by the Joint Commission, we are committed to the highest standards of service and reliability. EOE/Disabled/Veterans Location : Location US-NM-Clovis Recruiter : Full Name: First Last Gracie Barstad Direct phone number 314-744-4133 Recruiter : Email