Ingenesis Group - McConnell Air Force Base, KS
posted about 2 months ago
Full-time
McConnell Air Force Base, KS
Professional, Scientific, and Technical Services
About the position
The Utilization Management Nurse (RN) position at McConnell AFB involves working behind the scenes to enhance cost efficiency and quality in healthcare services. The role focuses on conducting reviews and audits to ensure patients receive necessary care while avoiding unnecessary procedures and prolonged hospital stays. Additionally, the nurse will educate patients about their healthcare coverage benefits and limitations.
Responsibilities
- Performs data/metrics collection on identified program areas; analyzes and trends results.
- Monitors specialty care referrals for appropriateness, covered benefits, and authorized surgery/medical procedures, laboratory, radiology, and pharmacy.
- Performs medical necessity review for planned inpatient and outpatient surgery.
- Acts as referral approval authority for designated referrals.
- Conducts referral reconciliation report, notifying appropriate personnel of open referrals.
- Presents case review summaries/finding to Medical Director at weekly Case Review Meetings as appropriate.
- Prepares and follows case for subsequent multi-level reviews as needed.
- Perform other duties as assigned.
Requirements
- Active Registered Nurse License (RN)
- At least 36 months of total nursing experience in a direct patient care clinical setting.
- Utilization management, utilization review or case management experience for 24 recent consecutive months.
- Certified/certification eligible in relevant specialty, such as Certified Managed Care Nurse or Certified Informatics Nursing.
