Registered Nurse - Utilization Management

Matrix Providers is hiring a Registered Nurse - Utilization Management to join our team of talented professionals who provide health care services to our Military Service Members and their families in at Buckley AFB, Aurora, CO. - Employment Status: Full Time - Compensation: $36.57 - $51.96 per hour - Benefits: Competitive financial package with a comprehensive insurance package including health, dental, vision, and life coverage. - Accrued Paid Time Off (PTO) - Paid Holidays (Outlined in Handbook) - 401(k) Plan Minimum Requirements Registered Nurse (RN) Utilization Management: - Degree/Education: Bachelors degree in nursing. - Certifications: Basic Life Support - Certified/certification eligible in relevant specialty such as: - Certified Managed Care Nurse through the American Board of Managed Care Nurses; Certification in Health Care Quality and Management (HCQM) through American Board of Quality Assurance and Utilization Review Physicians (ABQARP) - Certified Informatics Nursing, Ambulatory Care Nursing, Medical-Surgical Nursing or Nursing Case Management through the American Nurses Credentialing Center - Utilization Management Accreditation through National Committee for Quality Assurance (NCQA) are desired. - Experience: A minimum of 36 months total nursing experience in a direct patient care clinical setting. Must have utilization management, utilization review or case management experience for 12 recent consecutive months within the last 12 months. - Licensure/Registration: Current, full, active, and unrestricted license to practice as a Registered Nurse. Overview: Serve as a key member of the Utilization Management team, providing comprehensive support to TRICARE beneficiaries. Function independently to ensure appropriate, cost-effective healthcare delivery within TRICARE and Military Health System (MHS) guidelines. Key Responsibilities: - Manage a robust Utilization Management program, conducting reviews (prospective, concurrent, retrospective) to ensure proper use of patient care services. - Analyze trends, identify inefficiencies, and recommend process improvements to optimize patient care at appropriate levels. - Coordinate with military and civilian providers to ensure services meet medical necessity, cost-effectiveness, and TRICARE standards. - Serve as a resource for primary care managers, interpreting guidelines, monitoring referrals, and optimizing MTF and civilian healthcare services. - Identify and address access/utilization challenges, including enrollment, procedures, inpatient admissions, claims, and grievances. - Conduct systematic monitoring and evaluation of utilization metrics, identifying areas for improvement and reporting findings. - Provide training to healthcare providers on referral practices for quality and cost-effective care. Qualifications: - Advanced knowledge of TRICARE, MHS policies, and referral management systems. - Strong analytical skills with the ability to interpret data and recommend solutions. - Experience with Electronic Health Records (MHS Genesis preferred). - Interpersonal skills to collaborate effectively with diverse teams and stakeholders. Desired Skills: - Familiarity with government regulations, healthcare financing, and quality/risk management. - Proficiency in office automation software and DHA-approved documentation systems. This role supports healthcare excellence by optimizing resources, improving care quality, and ensuring compliance with TRICARE and DHA standards. We support our employees with an accessible dedicated representative to assist you throughout the duration of your contract. We firmly believe that a healthy work/life balance enables you to perform at your best. Our mission is to serve Americas military family by aligning exceptional healthcare workers like you with rew rding career opportunities. Come home to Matrix. Please Apply at: https://www.aplitrak.com/?adid=YmJnZW5lcmljLjA0MjE3Ljg3NjBAbWF0cml4Y29tcC5hcGxpdHJhay5jb20{rel="noopener noreferrer" target="_blank"}