About this opportunity
Luke Staffing lists this Registered Nurse - Utilization Management opportunity in township of goldsboro, North Carolina. Review the employer’s description below for duties, qualifications and application requirements.
Job description
Job Description
Registered Nurse - Utilization Management
SITE OF SERVICE
Seymour Johnson Air Force Base, NC. This position provides utilization management nursing services supporting the military treatment facility and its beneficiaries.
HOURS
Monday through Friday:
POSITION OVERVIEW
The Registered Nurse - Utilization Management provides clinical review and care coordination services at Seymour Johnson AFB. This is a non-personal services position that does not involve hands-on patient care. The RN-UM ensures appropriate utilization of healthcare resources, conducts medical necessity reviews, and coordinates care transitions. This position works independently and is not subject to day-to-day Government supervision comparable to military or civil service personnel.
POSITION QUALIFICATION/REQUIREMENTS
Degree: Graduate of an accredited nursing program (Associate's, Diploma, or Bachelor's degree in Nursing)
Licensure: Current, unrestricted Registered Nurse license in North Carolina (no licensure portability for non-personal services)
Case Management Certification: Must be certified or certification-eligible in relevant specialty such as Certified Managed Care Nurse (CMCN) through American Board of Managed Care Nurses, or certification through American Nurses Credentialing Center in Informatics Nursing, Ambulatory Care Nursing, Medical-Surgical Nursing, or Nursing Case Management
Other Certification: Current Basic Life Support (BLS) certification.
Experience: Current experience required is three years within the last four years as a
registered nurse in utilization management
Citizenship: U.S. Citizen required
Background: Must pass security investigation;
SF-85 required
DUTIES
Conduct utilization reviews to ensure medical necessity and appropriateness of care
Review and process referrals for specialty care and outside services
Perform concurrent and retrospective reviews of inpatient and outpatient services
Coordinate with healthcare providers to optimize patient care and resource utilization
Apply clinical criteria and guidelines (InterQual, Milliman, etc.) to assess level of care
Identify and address potential quality of care issues
Document review activities and decisions in accordance with regulatory requirements
Collaborate with case managers, social workers, and discharge planners
Communicate with TRICARE contractors and regional health commands as needed
Analyze utilization data and identify trends for process improvement
Ensure compliance with DHA, TRICARE, and MTF policies and procedures
Participate in utilization management committee meetings and quality initiatives
HEALTH REQUIREMENTS
TB Screening: Negative TB skin test within 12 months (if positive, negative chest X-ray with clearance letter)
Tdap: Proof of immunization required prior to start
Additional immunizations as required by MTF policy
SPECIAL REQUIREMENTS/SKILLS
This is a non-personal services position;
the Government will notsupervise or control the method by which the contractor performs required tasks. Strong knowledge of utilization management principles, TRICARE benefits and policies, and military health system operations preferred. Proficiency with electronic health records and utilization management software required. Excellent analytical, communication, and documentation skills essential. Must complete all agency-specified training requirements. Planned absences require 7 days advance notice to the COR.
LUKE is an Equal Opportunity Employer
LUKE is proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other protected class.
Learn more about us at lukestaffing.Com
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Worksite address
township of goldsboro, NC, 27531, US
Who can apply
Review the original listing for work authorization, qualifications and employer requirements.