RN - Utilization Management needed at Mountain Home Air Force Base in Mountain Home, Idaho.

Duties: The duties include, but are not limited to the following;

• Follows medical privacy and confidentiality (i.e. Health Insurance Portability and Accountability Act [HIPAA]) guidelines, The Joint Commission (TJC), and Clinical Practice Guidelines (CPGs).


• Works with computer applications/software to include Microsoft Office 365 programs, MS Outlook (e-mail) and internet usage.


• Must have a working knowledge of Ambulatory Procedure Grouping (APGs), Diagnostic Related Grouping (DRGs), International Classification of Diseases- Current Version (ICD), and Current Procedural Terminology-Current Version (CPT) coding; and McKesson (InterQual) and/or Milliman Care Guidelines.


• Performs prospective, concurrent, and retrospective reviews to justify medical necessity for requested medical care and to aid in collection and recovery from mult...