Registered Nurse - Utilization Management - 5006
RN - Utilization Management needed at Vandenberg Space Force Base.
Duties: The duties include, but are not limited to the following;
• 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 facility
• Perform physical exam and health histories
• Provide health promotions, counseling, and education.
• Administer medications, wound care, and numerous other personalized interventions.
• Direct and supervise care provided by other healthcare professionals.
• Accountable for making patient care assignments based on the scope of practice and skill level of assigned personnel.
• Recognize adverse signs and symptoms and quickly react in emergency situations.
• Communicate and collaborate with a diverse group of people for the purpose of informing the healthcare team of plans/action, for teaching/education to benefit the patient/family and organization.
• Make referral appointments and arrange speciality care as appropriate.
• Perform nursing services as identified in the TO.
• Conduct research in support of improved practice and patient outcomes.
Schedule:
Monday - Friday, 9 hours between 6:30am and 5:30pm, with a one-hour lunch
No Weekends or Holidays
Minimum Qualifications:
* Education: Minimum ASN from an accredited college or university
* Experience: One year of experience in Utilization Management is required. Full time employment as a registered nurse within the last 36 months is mandatory.
Must possess 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. Review process includes Direct Care and Purchase Care System referrals, ward rounds for clinical data collection, contacting providers to inform them of dollars lost for missing documentation, and providing documentation for appeals resolution. Possesses working knowledge of Ambulatory Procedure Grouping (APGs),Diagnostic Related Grouping (DRGs), International Classification of Diseases-Version 9(ICD), and Current Procedural Terminology-Version 4 (CPT-4) coding.
* Licensure: Current, full, active, and unrestricted RN license from any state.
* Life Support Certifications: AHA or ARC BLS Certification
* Security: Must possess ability to pass a Government background check/security clearance.
We are an equal opportunity employer and a drug free workplace. All applicants selected for employment are required to submit to a background check and pre-employment drug test.
Excellent Compensation & Exceptional Comprehensive Benefits:
* Paid Vacation, Paid Sick Time, Plus 11 Paid Federal Holidays!
* Medical/Dental/Vision, STD/LTD/Life, Health Savings Account available, and more!
* Annual CME Stipend and License/Certification Reimbursement!
* Matching 401K!
Base salary: $40.00 - $54.00/hr depending on experience
Average salary estimate
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