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Location

Little Rock, AR | United States

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Job description

GiaCare is now accepting resumes for a civilian RN Utilization Manager in anticipation for a future position at Little Rock AFB (Arkansas).

Job Qualifications:

Degree/Education: Baccalaureate degree (BSN) in Nursing.

Experience:

• Must have at least two years of total nursing experience in a direct patient care clinical setting. Must have UM, utilization review or case management experience for 24 recent consecutive months.
• Must be knowledgeable in medical privacy and confidentiality (Health Insurance Portability and Accountability Act [HIPAA]); accreditation standards of Accreditation Association for Ambulatory Health Care (AAAHC), The Joint Commission (TJC), and Clinical Practice Guidelines (CPGs).
• Must have a working knowledge of Ambulatory Procedure Grouping (APGs), Diagnostic Related Grouping (DRGs), International Classification of Diseases- Current Version (ICD), and Current Procedural Terminology-Current Version (CPT) coding; and McKesson (InterQual) and/or Milliman Care Guidelines.
• Must be able to perform prospective, concurrent, and retrospective reviews to justify medical necessity for requested medical care and to aid in collection and recovery from multiple insurance carriers.
• Must be able to collect clinical data from inpatient and outpatient sources; provide documentation for appeals or grievance resolution; apply critical thinking skills and expertise in resolving complicated healthcare, social, interpersonal and financial patient situations; apply problem-solving techniques to articulate medical requirements to patients, families/care givers, medical and non-medical staff in a professional and courteous way.

Certification:

• Basic Life Support (BLS)
• Certified/certification eligible in relevant specialty, such as Certified Managed Care Nurse through the American Board of Managed Care Nurses or Certified Informatics Nursing, Ambulatory Care Nursing, Medical-Surgical Nursing or Nursing Case Management through the American Nurses Credentialing Center.

Licensure/Registration: Current, full, active, and unrestricted license to practice as a RN


Job Duties:

• Coordinate patient care in collaboration with a wide array of healthcare professionals. Facilitate the achievement of optimal outcomes in relation to clinical care, quality, and cost effectiveness.
• Ensure compliance with standards of care and practice in accordance with all established policies, procedures, and guidelines used in the MTF.
• Develop and implement a comprehensive UM plan/program in accordance with the facility’s goals and strategic objectives.

As a GiaCare employee, you may enjoy the following benefits:

• Medical Insurance (100% covered by employer)
• Vision Insurance
• Dental Insurance
• Short-Term Disability Insurance
• Life and AD&D Insurance
• Paid Time Off (PTO)
• 401k (non-matching)
• Employee Referral Program
• A wide variety of employee discounts

Apply below or send resume to [email protected] or call (954) 651-9022 to speak with a recruiter immediately.

*GiaCare is an equal opportunity employer.

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Job tags

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Salary