Registered Nurse - Utilization Management

Pay:  $40.31/hr& $4.22*/hr for health & wellness pay (in lieu of benefits)

Location: Fort Carson

Schedule:

Works Monday through Friday. Shifts may be 8 to 10 hour per day, but will not go over 40
hours a week. Duties will need to be performed at the Colorado Military Health System (CMHS)
building during core CMHS hours (0600-1700).

Benefits: Vested vacation, sick leave, holiday leave, Life, Accidental Death and Dismemberment, Short Term Disability

Optional Benefits: Medical, Dental, Vision, 401(K) matching with employee participation in 401(K) plan

• Provide a comprehensive UM/Case/Care Management program for all TRICARE eligible
  beneficiaries.
• Acts as coordinator/liaison with providers, staff and Managed Care Support Contractor
  (MSCS) to ensure that actual health care received is appropriate to meet TRICARE beneficiaries
  healthcare needs.
• Identifies beneficiaries with complex healthcare needs who may benefit from alternative
  treatment modalities, mechanisms, and/or lower levels of care. Identifies areas of patient care
  services for process improvement to maximize utilization capabilities.
• Ensures that the healthcare service is within the scope of practice and the TRICARE
  Operations Manual (TOM) access to care standards for appropriate utilization of services.
  Performs utilization management/review for medical necessity for specialty referrals and
  appropriate level of care.
• Reviews and initiates recommendations to improve utilization activities throughout the
  continuum of care. Provides the communication link between the providers, staff, and civilian
  sectors with regard to utilization review guidelines. Determines if the services requested are
  medically appropriate, cost effective, and provided in the appropriate setting.
• Serves as a resource to and assists primary care managers with interpretation of guidelines
  and criteria for patient care and other systems. Identifies and describes trends using all
  appropriate resources/tools. Discusses any problems with the military medical treatment facility
  (MTF) providers and civilian providers and performs necessary follow-up with said providers.
• Reviews requests for patient care services within the Colorado Springs Multi-Service Market
  area which includes Evans Army Community Hospital, the United Sates Air Force Academy,
  Peterson AFB, Schriever AFB, and civilian providers for conditions that require medical care.
  Optimizes the MHS by redirecting care into the MTF when appropriate and by optimizing
  utilization of those primary and specialty care services in a timely manner.
• Analyze aspects of healthcare provisions within the catchment areas that affect the financial
  utilization of the Government by using professional nursing knowledge of a wide range of
  nursing concepts, the ability to function independently with little or no supervision, and
  understands all principles and practices.
• Interfaces with HNFS, local, state, and federal agencies responsible for financing
  alternatives in healthcare, such as Medicare, Medicaid, and TRICARE Managed Support
  Contractor those beneficiaries may be entitled to.
• Identifies problems with healthcare access and utilization in both the military and civilian
  sectors, and recommends alternatives. Problem areas may include enrollment, outpatient visits,
  procedures, emergency department visits, inpatient admissions, claims, appeals, grievances, and
  quality management issues.
• Utilizes criteria for the ongoing systematic monitoring and evaluation of patient care
  utilization to include tracking appropriate data. Identifies, documents, analyzes, reports, and
  recommends strategies for follow up in issues related to over/under utilization, high cost, high
  volume, quality and risk management
• Conducts regular training for staff healthcare providers to teach them important nuances
  related to writing appropriate referrals to ensure quality and cost-effective care provided.
• Demonstrate a wide theory base and sound clinical skills to function as a nursing generalist.
• Demonstrate customer-focused interpersonal skills in order to interact in an effective manner
  with physicians, health team members, community agencies,
  Centers, as well as clients and families with diverse opinions, values, and religious and cultural
  ideals.
• Knowledge of, and experience with Government regulations, procedures, limitations and
  requirements within the scope of their area highly desired. Working knowledge of latest versions
  of office automation software utilized in their area of expertise required; working knowledge of
  Composite Health Computer System (CHCS) desirable.

• English Language Requirement. The contractor shall read, understand, speak, and write
  English fluently, and be a United States citizen.
• Formal Education. Certification by a Utilization Management-specific program such as
  Certified Professional in Healthcare Management (CPHM) is desired.
• License: Current licensure to practice nursing in Colorado. Must be licensed in the
  jurisdiction in which the MTF is located (i.e. Colorado). Must maintain an active license or
  authorizing document from the state in which they are practicing at no expense to the government.
  Copies of license shall be furnished to the Contracting Officer or designated representative prior to
  performance.
• Certification: Basic Lifesaver Course (BLS) required.
• Experience: One year of experience in UM and five years of clinical experience in nursing
  desired

AKAHI ASSOCIATES LLC

AKAHI Associates is a premier provider of healthcare workers to various military treatment facilities across the United States. With a corporate office in Honolulu, Hawaii and recruiting office in San Antonio, Texas we specialize in providing skilled, trained and highly successful healthcare workers, including RNs, CRNAs, Physicians, LPN/LVN, Licensed Social Workers, and many more.

We have a strong focus on providing our government customers with quality and superior service.

Akahi Associates is an equal opportunity employer and Minorities, Females, Veterans, and Disabled persons are encouraged to apply. For further information, please click the link below to view the EEO Is The Law poster.

Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability or protected veteran status.

Only qualified individuals who are being considered will be contacted for an interview.