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Registered Nurse (RN) - Utilization Management - (220040)

Company: Luke & Associates Inc.
Location: Clovis
Posted on: January 17, 2022

Job Description:

Registered Nurse Utilization Management

Site Of Service

  • Cannon Air Force Base in Clovis, NM.

    • Health, Dental, Vision, Short Term Disability, Long term Disability, Life Insurance
    • 401 Retirement Plan
    • Annual CME Reimbursement
    • 10 paid federal Holidays
    • 80 Hours of Vacation
    • 56 Hours of Sick Leave

      Position Qualification/Requirements
      • Degree: Bachelors of Science in Nursing.
      • Experience: Must have at least 36 months of total nursing experience in a direct patient care clinical setting. Must have utilization management, utilization review or case management experience for 24 recent consecutive months.
      • Certifications:
        • Basic Life Support through AHA or ARC- Hands on Course
        • Certified/certification: eligible in relevant specialty, such as Certified Managed Care Nurse through the American Board of Managed Care Nurses or Certified Informatics Nursing, Ambulatory Care Nursing, Medical-Surgical Nursing or Nursing Case Management through the American Nurses Credentialing Center.
        • Licensure: Current, full, active and unrestricted license as a practical or vocational nurse from one of the 50 United States or U.S. territories.
        • U.S. Citizenship: HCWs performing under this contract shall be U.S. citizens.
        • Able to read, write, and speak English well enough to effectively communicate.
        • Shall be physically capable of standing and/or sitting for extended periods of time and physically capable of performing all services required under the contract.

          Core Duties
          • Develops and implements a comprehensive Utilization Management plan/program in accordance with the facilitys goals and strategic objectives.
          • Performs data/metrics collection on identified program areas; analyzes and trends results, including over- and underutilization of healthcare resources. Identifies areas for improvement and cost containment. Reports utilization patterns and provides feedback in a timely manner.
          • Analyzes medical referrals/appointments and general hospital procedures and regulations by monitoring specialty care referrals for appropriateness, covered benefits, and authorized surgery/medical procedures, laboratory, radiology and pharmacy.
          • Performs medical necessity review for planned inpatient and outpatient surgery; and performs concurrent review to include length of stay (LOS) for the facilitys inpatients using appropriate criteria.
          • Reviews previous and present medical care practices for patterns; trends incidents of under-or over-utilization of resources incidental to providing medical care.

            • Monday through Friday; 7:30am to 4:30pm
            • No Federal Holidays or designated family days

              Special Requirements/Skills

              Must be comfortable in a fast-paced, dynamic environment. Must be able and willing to reprioritize on short notice and work on multiple simultaneous projects. Flexible and able to work with various personalities. Team work skills required. Time management skills required. The ability to meet deadlines in a deadline intensive environment is essential. High level of adaptability and willingness to embrace change in a fast-paced, demanding environment.

              Luke & Associates does not discriminate on the basis of race, sex, color, religion, national origin, age, disability or veteran status in provision of services or employment opportunities and benefits.

              All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, or national origin.


              To learn more about Luke & Associates, please visit our website at:


Keywords: Luke & Associates Inc., Amarillo , Registered Nurse (RN) - Utilization Management - (220040), Healthcare , Clovis, Texas

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