Utilization Management Specialist - Registered Nurse

A career you can be proud of

Searching for a career that?s worthy of your dedication and talent? At TriWest Healthcare Alliance, a healthcare delivery support network for the Department of Defense, you?ll contribute to the health and well-being of the men and women who serve our country. Join us in the excellent opportunity to give back to those who work so hard at preserving our freedom.


TriWest Healthcare Alliance has the following opportunity at our Corporate Headquarters, Phoenix, AZ (I-17 Freeway & Greenway):


Utilization Management Specialist - Registered Nurse

 

Searching for a career that?s worthy of your dedication and talent? At TriWest Healthcare Alliance, a healthcare delivery support network for the Department of Defense, you?ll contribute to the health and well-being of the men and women who serve our country. Join us in the excellent opportunity to give back to those who work so hard at preserving our freedom.

This position will require a Department of Defense (DoD) background check which includes completing the Standard Form 85P questionnaire and fingerprinting.  DoD does NOT allow non-US citizens to begin work in this position prior to completion of the background checks, a process that can take several months.  Tri West will NOT hold a position open during the pendency of the background checks. 

 

This position is responsible for conducting first level review for medical necessity and authorization request for medical/surgical procedures. Gathers information needed to process concurrent review and authorization requests and documents in the medical management system.

 

? Assists with discharge planning, including authorization for services. Researches and utilizes community resources.

? Conducts prospective, retrospective & referral management.

? Screens available information against established guidelines to evaluate medical necessity and appropriateness of care.

? Performs telephonic continued stay UM reviews

? Identifies and refers beneficiaries to Case Management of Disease Management

? Identifies and refers potential quality issues and fraud and abuse cases

 

Qualifications:

? We are looking for an AZ unrestricted licensed RN with a minimum of 2-3 years clinical experience. 

? Ability to organize, prioritize, problem solve. Working computer knowledge.

? Managed Care experience preferred but will train candidates with strong clinical, computer, telephonic skills.

 


Our outstanding benefits package includes a 401(k) savings plan, 29 paid days off annually, medical/dental/life/disability insurance, education reimbursement, employee assistance program and quarterly incentive bonus. We are proud to be an equal opportunity employer providing a smoke/tabacco-free, drug-free environment. Successful applicants must pass a drug test and a DoD mandated background investigation. EOE


If your qualifications meet our minimum requirements, please submit your resume, along with salary requirements to