Utilization Management Registered Nurse

Spectrum Healthcare Resources has an excellent opportunity for a civilian Utilization Management Registered Nurse at FE Warren Air Force Base in Cheyenne, WY.

Full-time opportunity
• Monday - Friday (0700-1700)
• No weekends, on-call or holidays required
• Provide care and resources to military community
• Full complement of benefits to include health, dental and vision insurance, PTO, 11 Paid Holidays, 401(k) and more
• Pay range is $39-48/hour

Job Requirements:

• BSN Degree
• 6 years of clinical nursing experience and 1 year of utilization management experience required
• Knowledge, skills and computer literacy to interpret and apply medical care criteria, such as InterQual or Milliman Ambulatory Care Guidelines.
• Experience in performing prospective, concurrent, and retrospective reviews to justify medical necessity for medical care to aid in collection and recovery from multiple insurance carriers.
• Current RN license in Wyoming

Job duties:

• Monitor specialty care referrals for appropriateness, covered benefit, and authorized surgery/medical procedures, laboratory, radiology, pharmacy, and general hospital procedures and regulations to analyze medical referrals/appointments.
• Receives and makes patient telephone calls and computer/written correspondence regarding specialty clinic appointments and referrals.
• Develops and implements a comprehensive Utilization Management plan/program for beneficiaries within MTF's goals and objectives.

Company Overview:

At Spectrum, we utilize over thirty-five years of experience providing optimal solutions for federal agencies that are both innovative and cost-effective. We hold ourselves to the highest standard to ensure successful outcomes for the facilities and health care professionals we serve. As a Joint Commission Certified Healthcare Resource, dependability and service are the driving forces of our mission.

EOE/Disabled/Veterans