VieMed Healthcare Staffing is seeking a local contract nurse RN Utilization Review for a local contract nursing job in Aurora, Colorado.
Job Description & Requirements
- Specialty: Utilization Review
- Discipline: RN
- Start Date: 03/01/2025
- Duration: 52 weeks
- 40 hours per week
- Shift: 8 hours, days
- Employment Type: Local Contract
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 Minimum Requirements Registered Nurse (RN) Utilization Management: Degree/Education: Bachelor’s 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: 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.
About VieMed Healthcare Staffing
Established in 2021, VieMed Healthcare Staffing has brought together staffing operations and recruiting leadership with 30 years combined experience in healthcare staffing to build a clinician and client centric staffing agency. VHS is a Joint Commission certified staffing provider for nursing, allied, therapy, and locum contracts. Our recruitment team strives to provide qualified candidates with a seamless experience to match them with their desired assignments as we know this is the key to better patient care and experiences.
Benefits
