RN Utilization/Case Management (P/T)

IMMEDIATE OPENING for a part-time Registered Nurse Utilization Management (preferred) to support West Point, located in NY. There is some training and an associated exam after onboarding. This can be done remotely from home with the right equipment such as CAC reader, etc. The position also requires an annual recertification, with an exam but it is open book. There is the potential for the duties to be performed via telework after a while.

Qualifications:

• Degree: Associates Degree of Nursing, prefer Bachelor’s prepared RN
• Education: Graduate from a college or university accredited by Accreditation Commission for Education in Nursing (ACEN), the Commission on Collegiate Nursing Education (CCNE).
• Experience: Current Experience required is three years within the last four years as a registered nurse in utilization management.
• Certifications: Within 45 days of hiring, employee will complete an online course through NSQIP and must pass an initial exam with a grade of 90% or higher to earn a Surgical Clinical Reviewer (SCR) status. The SCR will be required to take a yearly open book exam and pass with 90% or higher. May require attendance of annual one-week NSQIP quality and safety conference. The government will cover expenses for trainings and conferences to include travel, lodging, meals, and miscellaneous expenses.
• Licensure: Current, full, active, and unrestricted license to practice as a registered nurse.

Responsibilities and duties but not limited to:

Supports a comprehensive MTF Utilization Management plan/program as prescribed in the DoD Medical Management Guide and at the direction of the MTF Utilization Management Director.

Actively and retrospectively reviews medical cases to confirm receipt of appropriate care, monitor for patterns/trends and develop action plan for areas requiring improvement.

Reports on utilization patterns; briefs provider staff and executive staff.

Maintains reports on which cases have been denied or received reduced third party payments and reports provider profiles to the MTF management for corrective action.

Participates on multi-disciplinary teams to resolve recurring problems in the healthcare delivery process for care within or outside the MTF including referrals.

Benefits include:

• Relocation Assistance (if needed)
• Paid Federal Holidays
• 10 Personal Leave Days
• Health & Welfare Reimbursement
• 401(K)
• Please email resume for immediate consideration.

Job Type: Part-time

Pay: From $1.00 per hour

Benefits:

• Relocation assistance

Work Location: In person