Registered Nurse (Utilization Review)

Job Description

Job Description

GiaCare Inc., in anticipation of a future government contract award, is now accepting applications for experienced, civilian Registered Nurses (Utilization Review Managers) to work alongside the federal government, in support of the Air Force Academy (Colorado Springs, Colorado).

Requirements :

Education : Associates Degree of Nursing (ADN) OR Bachelor of Science in Nursing (BSN). Graduate from a college or university accredited by Accreditation Commission for Education in Nursing (ACEN), the Commission on Collegiate Nursing Education (CCNE).

Certifications : Basic Life Support (BLS) certification

Board Certification : N / A

Licensure : Current, full, active, and unrestricted license to practice as a Registered Nurse.

Experience : One year as a Registered Nurse in Utilization Management. Three additional years as Registered Nurse in any clinical setting.

Duties :

Serves as coordinator / liaison with provider, staff, and patient to ensure that actual healthcare received is appropriate to meet TRICARE beneficiaries’ healthcare needs. Work involves gathering information, identifying, and analyzing data, and developing recommendations to resolve problems related to the appropriate utilization of patient care services at the appropriate level of care. Qualitative and quantitative analytical techniques, such as prospective, concurrent and retrospective reviews are applied when conducting studies along with determining the effectiveness of healthcare provided with ongoing refinement of methods, techniques and processes when conducting analysis in Utilization Review. Employee uses judgement to choose to interpret or adapt available guidelines to individual situations and problems and writes local guidelines and polices as needed. This requires the individual to fully understand patient care standards, criteria, and guidelines used to develop and / or adapt current referral management methodologies to recognized inefficiencies, to make recommendations on clinical practices, and institutionalize referral management concepts and practices.

As a GiaCare Inc. employee, you may enjoy the following benefits :

• Medical Insurance
• Vision Insurance
• Dental Insurance
• Short-Term Disability Insurance
• Life and AD&D Insurance
• Paid Time Off (PTO)
• 401k (non-matching)
• Employee Referral Program
• A wide variety of employee discounts
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