Registered Nurse (Utilization Review)

Job Description

Job Description

In anticipation of a future government contract award, GiaCare Inc. is now accepting applications for experienced, civilian Registered Nurses (Utilization Review Managers) in support of the Walter Reed National Medical Center (Bethesda, Maryland).

Requirements :

Education : Degree / Education : Degree or diploma for a professional nursing program approved by the legally designated State accrediting agency.

Certifications : Basic Life Support (BLS) certification

Board Certification : N / A

Licensure : Active current registration as a professional nurse in a State, District of Columbia, or a territory of the United States.

Duties :

This Registered Nurse will provide Referral Management (RM) activities including but not limited to the following : Timely processing of Right of First Refusal (ROFR) requests, screening of specialty care referrals, sustaining up-to-date Specialty Clinic Booking Guidance, MTF Capabilities Report, ROFR Reports, maintaining up-to-date MTF / Managed Care Support Contract (MCSC) Memorandums of Understanding (MOUs), comply with Referral and Authorization Business rules, tracking, accounting, and resulting of referrals, and full use of RM information management systems. Individual will conduct reviews for medical necessity, preauthorization, medical appeals, collection and recovery from insurance carriers, and right of first refusal activities.

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
• Must be an U.S. Citizen