Utilization Review Nurse (RN) Job at Matrix Providers, Aurora, CO

RlFLRGl2YlVydlRybU9USllPbXVCUllja2c9PQ==
  • Matrix Providers
  • Aurora, CO

Job Description

Experience the Matrix Providers Advantage. We strive to provide a framework of stability and structure for our valued employees, where you will experience lower provider-to-patient ratios and fair, reliable schedules.

Matrix Providers is hiring a Utilization Review Nurse (RN) 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 - $50.00 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: 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.

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 America�s military family by aligning exceptional healthcare workers like you with rewarding career opportunities.

Come home to Matrix.

Matrix Providers will never request any form of payment from candidates in exchange for consideration for employment. Furthermore, all communication from Matrix Providers will be conducted exclusively through official Matrix Providers email addresses. Any correspondence from alternative email addresses should be considered fraudulent.

Job Tags

Hourly pay, Holiday work, Full time, Contract work,

Similar Jobs

John Muir Health

RN - Meal Break Team - CMC Medical Surgical Acute Care - Part Time - 8 Hour - Nights Job at John Muir Health

 ...Education:* Graduate of an Accredited School of Nursing - RequiredExperience:* 6 Months Nursing - Acute Care - Preferred* 1000 hours Nursing - Medical/Surgical - Must be Obtained within last 2 years - Non-core RequirementCertification/Licensures:* RN Registered... 

Advocate Aurora Health

Registered Nurse (RN) Inpatient Case Manager Job at Advocate Aurora Health

 ...when patients are transferred. Provides case management services related to various levels of...  ...Registration/Certification: Registered Nurse License issued by the state in which the...  ...instructions and converse on standard telephone. This job description indicates the... 

Tutor Me Education

Online Teacher Job at Tutor Me Education

 ...Tutor Me Education is reshaping how students learn. We are looking for tutors and teachers to provide 1:1 or group instruction to students all across the country! Here are the details: Virtual instruction from your home computer, on your schedule! Set your... 

Pace Staffing Network

Tax/Accounting Assistant Job at Pace Staffing Network

 .../early May Job Type: Part-time Requirements: Basic accounting experience is required Professional tax preparation experience...  ...Puget Sound clients for over 45 years. We place a variety of temporary, contract and direct hire positions as well as interim-to-hire... 

AFIMAC Canada

Private Investigator - Injunction Investigator Job at AFIMAC Canada

 ...AFIMAC is seeking licensed Private Investigators for Injunction Investigative work in the GTA. ***Please note this is a temporary contract position, so it may not be suitable to someone currently working full time*** You will earn: You will earn approximately $3,1...