• Registered Nurse - Utilization Management

    Job Locations US-NV-Nellis AFB
    Posted Date 4 weeks ago(7/19/2018 8:44 PM)
    Job ID
    2018-2437
    # of Openings
    2
    Category
    Clinical
  • Overview

    ERP International, LLC (www.erpinternational.com) is seeking Utilization Management RNs to support the Mike O’Callaghan Federal Medical Center, Nellis Air Force Base, in Las Vegas, NV. Please apply online today to learn more about this great opportunity!

     

    About ERP International, LLC
    ERP is a nationally respected provider of health, science, and technology solutions supporting clients in the government and commercial sectors. We provide comprehensive enterprise information technology, strategic sourcing, and management solutions to DoD and federal civilian agencies in 40+ states. Founded in 2006, ERP is headquartered in Laurel, MD and maintains satellite offices in Montgomery, AL and San Antonio, TX - plus project locations nationwide.
     
    ERP offers exceptional benefits, including competitive compensation, Medical/Dental/Vision, short and long-term disability, life insurance, paid vacation, paid holidays, a matching 401(k), training and education opportunities, and semi-monthly direct deposit.

    Responsibilities

    Schedule:
    Normal schedule is Monday – Friday: 7:30am – 4:30pm, with a one hour lunch (40 hours/week)
    No Holidays/No Weekends
     
    Job Specific Details and Tasks:

     

    • Must have knowledge of 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 VA DoD Clinical Practice Guidelines (CPGs).
    • Must have a working knowledge of computer applications/software to include Microsoft Office programs, MS Outlook (e-mail) and internet familiarity
    • 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 have experience in Patient Advocacy, Patient Privacy, and Customer Relations.
    • Must be able to perform prospective, concurrent, and retrospective medical record (electronic (EHR) and hard copy) 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
    • Communication. Demonstrate ability to utilize verbal and written communication to work as a member of a team employing team building concepts in both multi -and inter-disciplinary setting to maintain medical and utilization management goals. Must be able to utilize customer service skills via phone, secure messaging and in person contacts to promote positive staff and patient interactions.

    Qualifications

    Minimum Qualifications:

    • BSN
    • Active/Unrestricted RN license from any state
    • Certification or eligible in relevant specialty
    • Minimum 3 years of active nursing practice, of which at least 2 years must be recent Utilization Management/Review or Case Management
    • Must be a U.S. Citizen and must be able to pass a government background check

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