Registered Nurse - Utilization Management in Ft. Eustis, Virginia at Professional Performance Development Group

Location: Langley AFB, VA

Professional Performance Development Group (PPDG) is seeking a dedicated Registered Nurse - Utilization Management to support healthcare operations at Langley Air Force Base. This position plays a critical role in ensuring appropriate utilization of healthcare resources, coordinating patient care, supporting case management activities, and promoting quality healthcare outcomes for military beneficiaries. Based on the Registered Nurse and Registered Nurse Case Manager minimum qualifications and core duties identified

The Registered Nurse - Utilization Management provides utilization management, care coordination, and case management support services. Working collaboratively with physicians, nurses, case managers, and multidisciplinary healthcare teams, the RN reviews healthcare services for medical necessity, resource utilization, quality outcomes, and continuity of care.

• Associate Degree in Nursing.
• Graduate from a college or university accredited by the Accreditation Commission for Education in Nursing (ACEN) or the Commission on Collegiate Nursing Education (CCNE).

• Current, full, active, and unrestricted Registered Nurse license.

• Experience: Current experience required is three years within the last four years as a

  registered nurse in utilization management.

• Current Basic Life Support (BLS) certification.

Candidates must be legally authorized to work in the United States and meet applicable contract requirements.

• Supports a comprehensive MTF Utilization Management plan/program as

  prescribed in the DoD Medical Management Guide and by 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

• Knowledge of utilization management, case management, and care coordination practices.
• Strong clinical assessment and critical thinking skills.
• Knowledge of healthcare regulations, accreditation standards, and quality improvement methodologies.
• Ability to evaluate medical necessity and healthcare resource utilization.
• Effective communication and collaboration skills.
• Proficiency in electronic medical record systems and healthcare databases.
• Strong organizational and documentation skills.