Job Posting for Registered Nurse - Referral Management at Decypher
Decypher is a leading integrator of professional, technology, and management solutions and services. We provide our services globally to Federal, Commercial, Local and State clients. Our employees are our most valuable asset and play an integral role in the success of Decypher and our clients. Working at Decypher is not a job, but a career where your talent and energy is respected, and you can personally make a difference. Decypher invites you to join our professional team. Decypher is an equal opportunity/affirmative action employer committed to diversifying its workforce (M/F/D/V).
Decypher is seeking a Registered Nurse - Referral Management candidate to provide support at Joint Base Lackland, San Antonio, TX.
Develops and implements a comprehensive Utilization Management plan/program
Performs data/metrics collection on identified program areas; analyzes and trends results, including over- and underutilization of healthcare resources
Analyzes medical referrals/appointments and general hospital procedures and regulations by monitoring specialty care referrals for appropriateness, covered benefits, and authorized surgery/medical procedures, laboratory, radiology and pharmacy
Reviews previous and present medical care practices for patterns; trends incidents of under-or over-utilization of resources incidental to providing medical care
Acts as referral approval authority for designated referrals per local/AF/DoD/national guidance and standards.
Associates Degree of Nursing (ASN)
Registered Nurse License
3 years of direct patient care in a clinical setting
2 years of consecutive utilization management, utilization review or case management experience