{"schemaVersion":"jobsearcher.job.v1","id":"5740b0cd9f501b9da0d2f509","url":"https://jobsearcher.com/jobs/5740b0cd9f501b9da0d2f509","canonicalUrl":"https://jobsearcher.com/jobs/5740b0cd9f501b9da0d2f509","title":"RN - Utilization Management","description":"Clovis, NM\nDetails\nHiring Company\nSpectrum Healthcare Resources\n\nPosition Description\nSpectrum Healthcare Resources is excited to offer a potential career opportunity for an Utilization Management Registered Nurse at the Cannon Air Force Base. This civilian position is an outstanding chance to contribute to the health and well-being of our military members while enjoying a rewarding work-life balance and a supportive patient community.\nJoin us in making a significant impact on the lives of those who serve our country, with a focus on quality care and professional development!\nRequirements:\nBaccalaureate of Science in Nursing Program from an approved National League of Nursing.\nCurrent, active, full, and unrestricted License to practice Nursing in accordance with State Board requirements. Nurse applicants must be a current U.S. licensed Registered Nurse.\nLicense cannot be under investigation nor have any adverse action pending from a Nursing State Board or national licensing/certification agency.\nSix years of clinical nursing experience is required.\nOne year of previous experience in Utilization Management is required.\nFull-time employment in a nursing field within the last 36 months is mandatory.\nEquivalent combinations of education and experience may be qualifying if approved by the requesting location and the Contracting Officer. If education or experience is used to meet the specialized requirements of this position, it must be directly related to referral/utilization management.\nJob Responsibilities:\nReferral Monitoring: Reviews specialty care referrals for appropriateness, benefits, and authorization. Coordinates with TRICARE and MTF Liaison for clarification.\nStaff Training: Assists in orienting and training Medical Management staff. Ensures Health Service Inspection standards are met.\nPatient Communication: Handles patient calls and correspondence regarding appointments and referrals. Monitors CHCS queue for patient follow-ups.\nData Entry: Gathers and inputs patient information into CHCS, AHLTA, MHS GENESIS, and other databases.\nApproval Authority: Approves active duty and reserve/guard referrals. Verifies eligibility and coordinates communications.\nReferral Processing: Processes first right of refusal referrals within one business day. Updates reports and capability databases.\nUtilization Management Plan: Develops and implements a comprehensive plan following the DoD Medical Management Guide.\nMedical Care Review: Analyzes medical care practices for trends and under/over-utilization. Provides feedback on utilization review issues.\nData Analysis: Collects and analyzes data, preparing reports on resource utilization. Identifies areas for improvement.\nReporting: Maintains reports on denied/reduced payments and provider profiles. Liaises with higher headquarters and organizations.\nDaily Operations: Ensures daily reconciliation of open referrals. Monitors admissions to civilian hospitals and submits monthly reports.\nEducation Programs: Participates in continuing education and in-services. Serves on the Prime Service Area Executive Council.\nInterpersonal Relations: Maintains good relationships with team members and addresses concerns through the Utilization Management Director.\nIndependent Work: Manages projects independently, developing procedures and guidelines based on observations and reviews.\nCompany Overview:\nAt Spectrum, we leverage over thirty-five years of experience to deliver innovative and cost-effective solutions for federal agencies. Certified by the Joint Commission, we are committed to the highest standards of service and reliability. Spectrum Healthcare Resources is proud to be an equal opportunity employer, welcoming applications from all qualified individuals, regardless of race, color, religion, sex, national origin, disability status, protected veteran status, or any other protected characteristic.\nUS-NM-Clovis Gracie Barstad 314-744-4133 gracie_barstad@spectrumhealth.com","company":"Nursing Network","rawCompany":"nursingnetwork","city":"Clovis","state":"NM","isRemote":false,"isActive":false,"createdAt":"2026-04-12T21:07:00.527Z","occupations":[{"code":"29-1141.00","title":"Registered Nurses","slug":"registered-nurses"},{"code":"29-1141.04","title":"Clinical Nurse Specialists","slug":"clinical-nurse-specialists"},{"code":"29-1141.01","title":"Acute Care Nurses","slug":"acute-care-nurses"}],"industries":[{"code":"622110","title":"General Medical and Surgical Hospitals","slug":"general-medical-and-surgical-hospitals"},{"code":"621498","title":"All Other Outpatient Care Centers","slug":"all-other-outpatient-care-centers"},{"code":"621999","title":"All Other Miscellaneous Ambulatory Health Care Services","slug":"all-other-miscellaneous-ambulatory-health-care-services"}],"jobPosting":{"@context":"https://schema.org","@type":"JobPosting","title":"RN - Utilization Management","description":"Clovis, NM\nDetails\nHiring Company\nSpectrum Healthcare Resources\n\nPosition Description\nSpectrum Healthcare Resources is excited to offer a potential career opportunity for an Utilization Management Registered Nurse at the Cannon Air Force Base. This civilian position is an outstanding chance to contribute to the health and well-being of our military members while enjoying a rewarding work-life balance and a supportive patient community.\nJoin us in making a significant impact on the lives of those who serve our country, with a focus on quality care and professional development!\nRequirements:\nBaccalaureate of Science in Nursing Program from an approved National League of Nursing.\nCurrent, active, full, and unrestricted License to practice Nursing in accordance with State Board requirements. Nurse applicants must be a current U.S. licensed Registered Nurse.\nLicense cannot be under investigation nor have any adverse action pending from a Nursing State Board or national licensing/certification agency.\nSix years of clinical nursing experience is required.\nOne year of previous experience in Utilization Management is required.\nFull-time employment in a nursing field within the last 36 months is mandatory.\nEquivalent combinations of education and experience may be qualifying if approved by the requesting location and the Contracting Officer. If education or experience is used to meet the specialized requirements of this position, it must be directly related to referral/utilization management.\nJob Responsibilities:\nReferral Monitoring: Reviews specialty care referrals for appropriateness, benefits, and authorization. Coordinates with TRICARE and MTF Liaison for clarification.\nStaff Training: Assists in orienting and training Medical Management staff. Ensures Health Service Inspection standards are met.\nPatient Communication: Handles patient calls and correspondence regarding appointments and referrals. Monitors CHCS queue for patient follow-ups.\nData Entry: Gathers and inputs patient information into CHCS, AHLTA, MHS GENESIS, and other databases.\nApproval Authority: Approves active duty and reserve/guard referrals. Verifies eligibility and coordinates communications.\nReferral Processing: Processes first right of refusal referrals within one business day. Updates reports and capability databases.\nUtilization Management Plan: Develops and implements a comprehensive plan following the DoD Medical Management Guide.\nMedical Care Review: Analyzes medical care practices for trends and under/over-utilization. Provides feedback on utilization review issues.\nData Analysis: Collects and analyzes data, preparing reports on resource utilization. Identifies areas for improvement.\nReporting: Maintains reports on denied/reduced payments and provider profiles. Liaises with higher headquarters and organizations.\nDaily Operations: Ensures daily reconciliation of open referrals. Monitors admissions to civilian hospitals and submits monthly reports.\nEducation Programs: Participates in continuing education and in-services. Serves on the Prime Service Area Executive Council.\nInterpersonal Relations: Maintains good relationships with team members and addresses concerns through the Utilization Management Director.\nIndependent Work: Manages projects independently, developing procedures and guidelines based on observations and reviews.\nCompany Overview:\nAt Spectrum, we leverage over thirty-five years of experience to deliver innovative and cost-effective solutions for federal agencies. Certified by the Joint Commission, we are committed to the highest standards of service and reliability. Spectrum Healthcare Resources is proud to be an equal opportunity employer, welcoming applications from all qualified individuals, regardless of race, color, religion, sex, national origin, disability status, protected veteran status, or any other protected characteristic.\nUS-NM-Clovis Gracie Barstad 314-744-4133 gracie_barstad@spectrumhealth.com","datePosted":"2026-04-12T21:07:00.527Z","dateModified":"2026-04-12T21:07:00.527Z","hiringOrganization":{"@type":"Organization","name":"Nursing Network","sameAs":"https://jobsearcher.com"},"jobLocation":{"@type":"Place","address":{"@type":"PostalAddress","addressLocality":"Clovis","addressRegion":"NM","addressCountry":"US"}},"identifier":{"@type":"PropertyValue","name":"JobSearcher","value":"5740b0cd9f501b9da0d2f509"},"url":"https://jobsearcher.com/jobs/5740b0cd9f501b9da0d2f509"}}