Spectrum Healthcare Resources has an exciting Potential opportunity for a Utilization Management Registered Nurse in support of Navy Medicine Readiness Training Command at Naval Health Clinic in Corpus Christi, Texas.

Job Requirements:

Degree/Education (5.2.4): Baccalaureate of Science in Nursing Program from a program approved by the Accreditation Center for Education in Nursing (ACEN, formerly NLNAC) or the Commission on Collegiate Nurse Education (CCNE)
• Experience: 6 years of clinical nursing experience is required. One year of previous experience in Utilization Management is required. Full time employment in a nursing field within the last 36 months is mandatory. Equivalent combinations of education and experience may be qualifying if approved by the requesting location and the Contracting Officer. If education or experience is used to meet the specialized requirements of this position, it must be directly related to referral/utilization management.
• Board Certification: Baccalaureate of Science in Nursing Program from a program approved by the Accreditation Center for Education in Nursing (ACEN, formerly NLNAC) or the Commission on Collegiate Nurse Education (CCNE)

• Licensure/Registration: Current, active, full, and unrestricted License to practice Nursing in accordance with State Board requirements. Nurse applicants must be a current U.S. licensed Registered Nurse. License cannot be under investigation nor have any adverse action pending from a Nursing State Board or national licensing/certification agency.

• Continuing Education (i.e., CME, CDE, CEU) completed in past 2 years. Copies of certificates and/or computer printouts are acceptable.

Duties:

• Assist with orientation and training of other Medical Management staff. Assists MTF officials to ensure Health Service Inspection standards are met at the operational level.
• 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.
• Participates in in-services and continuing education programs. Briefs applicable data/slides to provider staff, executive staff, newcomers, as appropriate.
• Participate in all phases of the Utilization Management Program (UMP) and ensure that the UMP meets established Utilization Management (UM) standards of care. Assist in coordinating a multidisciplinary team to meet the health care needs, including medical and/or psychosocial management of specified patients. Perform a full range of utilization management services including referrals, care coordination, utilization review, discharge planning, continued stay reviews, and appeal reviews.
• Serve as consultant to all disciplines regarding UM issues. Provide nursing expertise about the UM process, including assessment, planning, implementation, coordination, and monitoring.
• Collect and analyze clinical utilization data to identify information on resource consumption and outcomes of care.
• Develop and implement tools to support utilization management, such as those used for patient identification and patient assessment, clinical practice guidelines, algorithms, UM software, databases for community resources, etc.
• Prepare routine reports and conduct analyses relating to Utilization Management initiatives.

Position will Offer:

• Full time; Monday - Friday
• PTO and sick leave
• Paid federal holidays
• Medical/Dental/Vision/401k

For More Information Contact:

Laura Hatcher

314-744-4156

Laura_Hatcher@spectrumhealth.com

Company Overview:

Spectrum Healthcare Resources (SHR) was established in 1988 to deliver systems and processes designed to meet the unique needs of Military and VA Health Systems. SHR is a leading organization that provides physician and clinical staffing and management services to United States Military Treatment Facilities, VA clinics and other Federal Agencies through various contracting vehicles. A Joint Commission Health Care Staffing Services firm, SHR is the military staffing division of TeamHealth, a Nationwide organization that serves 850 civilian and military hospitals with a team of 9,600 affiliated health care professionals.

Spectrum Healthcare Resources is an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status, or any other characteristic protected by law.