Registered Nurse - Utilization Management (RN-UM)

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.