Registered Nurse – Utilization Management

Entourage is accepting resumes for this role:

Registered Nurse – Utilization Management
Place of Performance: Japan

Specific Tasks:

• Supports a comprehensive MTF Utilization Management plan/program as prescribed in the DoD Medical Management Guide and at the direction of 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.

Qualifications:

• Degree: Associates Degree of Nursing.
• Education: Graduate from a college or university accredited by Accreditation Commission for Education in Nursing (ACEN), the Commission on Collegiate Nursing Education (CCNE).
• Experience: Current experience required is three years within the last four years as a registered nurse in utilization management.
• Licensure: Current, full, active, and unrestricted license to practice as a registered nurse.