Ready to make your next career move? VieMed Healthcare Staffing is a premier staffing agency that specializes in connecting skilled professionals with healthcare facilities, ensuring seamless continuity of care and unparalleled service delivery. We are committed to quality, reliability, and integrity for both our candidates and clients. Join us in our mission to elevate healthcare staffing to new heights. We take care of you, so you can take care of others.
VHS is looking for a qualified Registered Nurse - Utilization Management
City:Aurora
State: CO
Start Date 2025-03-01
End Date: 2027-11-30
Duration: 1 Year minimum contract with option to renew
Shift: 8 Hours Day shift Monday thru Friday.
Skills: Nursing
W2 Pay Rate: $46.00/hr plus 11 Paid Federal Holidays and Health and Wellness package
Certification Requirements: Please confirm credential requirements with VHS upon application.
At VieMed, Live Your Life isn't just a company tagline. It's a passionate commitment to improving the lives of every patient and employee. Benefits Include:
Competitive Pay Packages
Weekly Pay Schedule via Direct Deposit
Comprehensive Medical Benefits
Dental and Vision Supplemental Benefits
401(k) with match
Robust Referral Bonus Program
24/7 Dedicated team committed to your success throughout your time with VHS
Paid sick time in accordance with all applicable state, federal and local laws
Licensure, certification, travel and other reimbursements when applicable
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: Minimum of 36 months total nursing experience in a direct patient care clinical setting and 12 months consecutive experience in utilization management, utilization review or case management.
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.
**VHS is an Equal Opportunity Employer (“EEO”)/Protected Veterans/Individuals with Disabilities/E-Verify Employer and welcomes all to apply** #LiveYourLife #matrix
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About Aurora, CO
Ready to embark on an exciting career journey in Aurora, Colorado? This vibrant city located in the beautiful state of Colorado offers a perfect blend of urban amenities and outdoor adventures, making it an ideal place to live and work. From its close proximity to the stunning Rocky Mountains for weekend getaways to the famous Red Rocks Amphitheatre for world-class concerts, Aurora has something for everyone. With a thriving arts scene, delicious local cuisine, and easy access to professional sports teams like the Denver Broncos at Mile High Stadium, this region truly has it all. Explore our job listings today and discover why Aurora is the perfect place to grow your career!
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VieMed is a great workplace where every employee is valued and protected as a member of the VieMed family. We are aware of a common scam where fake company positions/jobs are posted online.
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