FirstBank Jobs

Job Title Utilization Management Nurse

Location USAF ACADEMY, CO US (Primary)

Job Type Full-time

Job Description

SUMMARY Responsible for assuring the receipt of high quality, cost efficient medical outcomes for those enrollees identified as having the need for inpatient/outpatient precertification. ESSENTIAL DUTIES & RESPONSIBILITIES Review precertification requests for medical necessity, referring to the Medical Director those that require additional expertise. Review clinical information for concurrent reviews. As part of the UMRN program, conduct ongoing availability, monitoring and oversight of non-clinical staff activities. Establish effective rapport with other employees, professional support service staff, customers, clients, patients, families, and physicians. Employ effective use of knowledge, critical thinking, and skills to: Advocate quality care and enhanced quality of life. Prevent patient complications during hospital stay. Advocate decreased hospital stay when appropriate. Maintain accurate records of all patient related interactions. Maintain regular and punctual attendance. Perform other duties as assigned. SUPERVISORY RESPONSIBILITIES None

Job Requirements

MINIMUM QUALIFICATIONS Bachelor of Science in Nursing (BSN) is required. Minimum of two (2) years of prior experience in Utilization Management. Must possess a current, active, full, and unrestricted Registered Nurses (RN) licensed in Colorado, be able to practice using a nurse compact state license or have a license from any United States jurisdiction (with no limitations, stipulations or pending adverse actions). Knowledge of medical privacy and confidentiality (Health Insurance Portability and Accountability Act[HIPAA]), and accreditation standards of Accreditation Association for Ambulatory Health Care (AAAHC), The Joint Commission (TJC), and Clinical Practice Guidelines (CPGs). Must have knowledge and experience, or demonstrate comprehension during training, with software and databases currently employed at the MTF (e.g., Microsoft Office, Access, Excel, and PowerPoint; Composite Health Care System [CHCS], Armed Forces Health Longitudinal Technological Application [AHLTA]). 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 Gui Must have and maintain current certification in Basic Life Support (BLS) from the American Red Cross. This certificate must be current at all times. Must obtain and maintain the site's required health screening and immunization requirements. Must obtain and maintain all required documents, certifications, licenses, etc. listed on the credentiallingchecklist, sent by Katmai's Credentialing... For full info follow application link.

We are a VEVRAA Federal Contractor

We are an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to age, race, color, religion, sex, sexual orientation, gender identity or national origin, disability status, protected veteran status, or any other characteristic protected by law.

Preference will be given to Ouzinkie Shareholders, Spouses of Shareholders, and Descendants of Shareholders in accordance with Title 43 U.S. Code 1626(g) and Title 42 U.S. Code 2000e - 2(i).

Executive Order 11246, as amended, protects applicants and employees from discrimination based on inquiring about, disclosing, or discussing their compensation or the compensation of other applicants or employees.

Posters:

Equal Employment Opportunity is the Law Poster: https://katmai.egnyte.com/dl/FrUjevEY7z

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Pay Transparency Poster: https://katmai.egnyte.com/dl/XP6htB3UCc

Right to ork Poster: https://katmai.egnyte.com/dl/KGGBPdDBaV

Right to Work Poster (Spanish): https://katmai.egnyte.com/dl/vUsEZp98X4