Utilization Review Nurse RN
Utilization Review Nurse RN
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Job Description
Experience the Matrix Providers Advantage. We strive to provide a framework of stability and structure for our valued employees where you will experience lower providertopatient ratios and fair reliable schedules.
Matrix Providers is hiring a Utilization Review Nurse (RN) to join our team of talented professionals who provide health care services to our Military Service Members and their families in at Buckley AFB Aurora CO.
- Employment Status: Full Time
- Compensation: $36.57 $50.00 per hour
- Benefits: Competitive financial package with a comprehensive insurance package including health dental vision and life coverage.
- Accrued Paid Time Off (PTO)
- Paid Holidays (Outlined in Handbook)
- 401(k) Plan
Minimum Requirements Registered Nurse (RN) Utilization Management:
Degree/Education: Bachelors degree in nursing.
Certifications: Basic Life Support
Certified/certification eligible in relevant specialty such as:
- Certified Managed Care Nurse through the American Board of Managed Care Nurses; Certification in Health Care Quality and Management (HCQM) through American Board of Quality Assurance and Utilization Review Physicians (ABQARP)
- Certified Informatics Nursing Ambulatory Care Nursing MedicalSurgical Nursing or Nursing Case Management through the American Nurses Credentialing Center
- Utilization Management Accreditation through National Committee for Quality Assurance (NCQA) are desired.
Experience: Minimum of 36 months total nursing experience in a direct patient care clinical setting and 12 months consecutive experience in utilization management utilization review or case management.
Licensure/Registration: Current full active and unrestricted license to practice as a Registered Nurse.
Overview:
Serve as a key member of the Utilization Management team providing comprehensive support to TRICARE beneficiaries. Function independently to ensure appropriate costeffective healthcare delivery within TRICARE and Military Health System (MHS) guidelines.
Key Responsibilities:
- Manage a robust Utilization Management program conducting reviews (prospective concurrent retrospective) to ensure proper use of patient care services.
- Analyze trends identify inefficiencies and recommend process improvements to optimize patient care at appropriate levels.
- Coordinate with military and civilian providers to ensure services meet medical necessity costeffectiveness and TRICARE standards.
- Serve as a resource for primary care managers interpreting guidelines monitoring referrals and optimizing MTF and civilian healthcare services.
- Identify and address access/utilization challenges including enrollment procedures inpatient admissions claims and grievances.
- Conduct systematic monitoring and evaluation of utilization metrics identifying areas for improvement and reporting findings.
- Provide training to healthcare providers on referral practices for quality and costeffective care.
Qualifications:
- Advanced knowledge of TRICARE MHS policies and referral management systems.
- Strong analytical skills with the ability to interpret data and recommend solutions.
- Experience with Electronic Health Records (MHS Genesis preferred).
- Interpersonal skills to collaborate effectively with diverse teams and stakeholders.
Desired Skills:
- Familiarity with government regulations healthcare financing and quality/risk management.
- Proficiency in office automation software and DHAapproved documentation systems.
This role supports healthcare excellence by optimizing resources improving care quality and ensuring compliance with TRICARE and DHA standards.
We support our employees with an accessible dedicated representative to assist you throughout the duration of your contract. We firmly believe that a healthy work/life balance enables you to perform at your best. Our mission is to serve Americas military family by aligning exceptional healthcare workers like you with rewarding career opportunities.
Come home to Matrix.
Matrix Providers will never request any form of payment from candidates in exchange for consideration for employment. Furthermore all communication from Matrix Providers will be conducted exclusively through official Matrix Providers email addresses. Any correspondence from alternative email addresses should be considered fraudulent.
Matrix Providers is an equal opportunity employer. Qualified applicants will receive consideration for employment regardless of race color religion sex sexual orientation gender identity national origin disability or protected veteran status. For our EEO Policy Statement please see https://matrixproviders/accessibilityeeodisclaimer. To learn more about our Benefits Packages please see https://matrixproviders/benefits.
Matrix Providers endeavors to make www.matrixproviders accessible to all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process please get in touch with our Recruiting Hotline NumberTTY LINE. This contact information is for accommodation requests only and cannot be used to inquire about the status of applications.
Employment Type
Hourly
