Job Description
Job Title:Registered Nurse - Utilization Management (RN-UM)
Location: Colorado Military Health System (CMHS), Fort Carson, CO, 80913
Tentative Start Date: December 1, 2025
Work Schedule: Monday–Friday, 8-hour shifts between 0600–1700, excluding federal holidays
Qualifications:
- Education: Graduate of an accredited school of nursing (BSN preferred).
- Experience:
- Minimum of 1 year of Utilization Review/Management experience.
- Minimum of 3 years of clinical nursing experience.
- Experience with TRICARE and military healthcare systems is highly desirable.
- License/Certification: Current, full, active, unrestricted RN license in a U.S. jurisdiction; BLS certification required.
- Other Requirements: Must be a U.S. Citizen; excellent analytical, communication, and organizational skills.
Documents Required for Submission:
- Updated Resume (With all gaps explained)
- Current, full, active, unrestricted license as a Registered Nurse in any U.S. state or territory.
- Basic Life Support (BLS) certification.
Responsibilities:
- Conduct utilization management reviews to ensure healthcare services are medically necessary, appropriate, and cost-effective.
- Act as a liaison with providers, referral centers, and TRICARE contractors to ensure patients receive care at the appropriate level and location.
- Apply clinical knowledge to review medical necessities for specialty referrals, inpatient admissions, and outpatient services.
- Prepare and analyze reports on utilization data and healthcare trends to identify inefficiencies or over/under-utilization.
- Identify high-cost or complex cases, collaborating with case managers and providers to optimize patient care planning.
- Ensure patient care complies with TRICARE access-to-care standards and DHA utilization policies.
- Educate providers and staff on referral management processes and utilization criteria.
- Support process improvement initiatives to enhance referral and utilization management across the CMHS.
- Maintain accurate documentation of all utilization management activities in EHR systems.
- Protect patient confidentiality and comply with HIPAA and DoD privacy requirements.
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