Analysis Skills, Basic Life Support (BLS), Case Management, Clinical Nursing, Communication Skills, Data Analysis, Documentation, Healthcare, Medical Record System, Military, Organizational Skills, Outpatient Care, Patient Admissions, Patient Care, People Management, Process Improvement, Registered Nurse (RN), Standards of Care, Systems Administration/Management, Trend Analysis, United States Citizen, Utilization Management
Job Title:Registered Nurse - Utilization Management (RN-UM)
Location: Colorado Military Health System (CMHS), Fort Carson, CO, 80913
Tentative Start Date: December 1, 2025
Work Schedule: Monday–Friday, 8-hour shifts between 0600–1700, excluding federal holidays
Qualifications:
- Education: Graduate of an accredited school of nursing (BSN preferred).
- Experience:
- Minimum of 1 year of Utilization Review/Management experience.
- Minimum of 3 years of clinical nursing experience.
- Experience with TRICARE and military healthcare systems is highly desirable.
- License/Certification: Current, full, active, unrestricted RN license in a U.S. jurisdiction; BLS certification required.
- Other Requirements: Must be a U.S. Citizen; excellent analytical, communication, and organizational skills.
Documents Required for Submission:
- Updated Resume (With all gaps explained)
- Current, full, active, unrestricted license as a Registered Nurse in any U.S. state or territory.
- Basic Life Support (BLS) certification.
Responsibilities:
- Conduct utilization management reviews to ensure healthcare services are medically necessary, appropriate, and cost-effective.
- Act as a liaison with providers, referral centers, and TRICARE contractors to ensure patients receive care at the appropriate level and location.
- Apply clinical knowledge to review medical necessities for specialty referrals, inpatient admissions, and outpatient services.
- Prepare and analyze reports on utilization data and healthcare trends to identify inefficiencies or over/under-utilization.
- Identify high-cost or complex cases, collaborating with case managers and providers to optimize patient care planning.
- Ensure patient care complies with TRICARE access-to-care standards and DHA utilization policies.
- Educate providers and staff on referral management processes and utilization criteria.
- Support process improvement initiatives to enhance referral and utilization management across the CMHS.
- Maintain accurate documentation of all utilization management activities in EHR systems.
- Protect patient confidentiality and comply with HIPAA and DoD privacy requirements.
Powered by JazzHR