Registered Nurse (RN), Utilization Management, Washington, D.C.

Title: Registered Nurse (RN), Utilization Management (UM) Location: Joint Base Anacostia Bolling, Washington, .D.C. Position Type: Full time (40 hours/week), hourly.  FLSA Status: Non-exempt  Education Level: ADN Job Category: Health Care Our Company Promise:  We are committed to providing our Employees a stable work environment with equal opportunity for learning and personal growth. Vighter’s Mission is to provide efficient, fast, high-quality healthcare staffing to our clients. Our Culture’s 5 key elements are crucial to the effectiveness of our employees in accomplishing our mission. These elements are:  ● Dependability  ● Integrity  ● Personability  ● Transparency  ● Responsiveness  Creating and cultivating this Culture within the organization is our commitment to our employees. Above all, Vighter employees will be provided the same concern, respect, and caring attitude that they are expected to share externally with every Vighter Client and Customer. Summary: Vighter is recruiting Registered Nurse (RN), Utilization Management to provide patient care and administrative support at Joint Base Anacostia-Bolling, Washington, DC. In accordance with established policies, procedures, protocols, and guidelines, while supporting the healthcare needs of Service Members, their families, and Veterans. Vighter is a Service Disabled, Veteran Owned Small Business that is accredited by both the Joint Commission and ISO-9001. With our dedication to continuous improvement, Vighter assists in the provision of the highest standards of care. Principal Accountabilities: * Perform Utilization Management and Utilization Review activities. * Review services for medical necessity, appropriate utilization, quality, and cost effectiveness. * Monitor inpatient length of stay, outpatient procedures, referrals, and specialty care. * Identify overutilization, underutilization, trends, and improvement opportunities. * Collect, analyze, and report utilization data and performance metrics. * Verify beneficiary eligibility through DEERS. * Manage and monitor referrals through MHS GENESIS and applicable referral systems. * Coordinate with TRICARE, MTF staff, providers, Case Managers, and outside agencies. * Monitor referrals, appointments, procedures, testing, pharmacy services and covered benefits. * Complete referral reconciliation, medical record documentation, coding, tracking logs and reports. * Participate in interdisciplinary, Care Coordination, and Utilization Management meetings. * Support staff training, quality improvement, patient safety, and medical readiness activities. * Follow applicable MTF, DoD, CMSA, URAC, HIPAA, infection-control, and safety requirements. * Complete required EMR, MTF orientation, and Utilization Management training. * Promote safe, efficient, high-quality nursing care and identify issues that could negatively affect patient outcomes.  Knowledge and Skills: * Knowledge of HIPAA, AAAHC, The Joint Commission and Clinical Practice Guidelines. * Knowledge of APGs, DRGs, ICD, CPT, InterQual, and/or Milliman Care Guidelines. * Working knowledge of TRICARE and military healthcare systems preferred. * Proficient with Microsoft Office, Outlook, and electronic medical records. * Experience with patient advocacy, privacy, and customer relations. * Strong critical-thinking, communication, and problem-solving skills. * Ability to perform prospective, concurrent, and retrospective medical necessity reviews. Education: * Associate’s degree in nursing (ADN) is required. Qualifications: * Minimum of three (3) years of direct patient care nursing experience.  * Minimum of two (2) recent, consecutive years in utilization management, utilization review, or case management.  * Current, active, and unrestricted Registered Nurse license. * Current Basic Life Support (BLS) certification is required. * Certified or certification-eligible in a relevant specialty, such as Managed Care Nursing, Nursing Case Management, Ambulatory Care Nursing, Medical-Surgical Nursing, or Informatics Nursing. Duty Hours / On-call Requirements:  * The expected duty hours for this position are 8 hours per day and 5 days per week. However, this position supports 24/7 operations which may require work to be conducted at night and on weekends. Work Environment: * Location: Joint Base Anacostia-Bolling (JBAB), Washington, DC * Supportive team of healthcare professionals and administrative staff. * Opportunity to work with diverse populations, including Service Members, Veterans, retirees and their families. Travel: * As required to satisfy the contractual obligations. Commuting is non-compensatory. All official travel is government funded.  Benefits:  * Competitive hourly rate + health and welfare paid in cash. * A comprehensive benefits package, with Medical, Dental, and Vision insurance available for W2 full-time employees. * Company-paid basic Life and AD&D insurance. Best in class rates for Voluntary life insurance. * Vacation accrual and paid holidays (Per SCA Rules). Physical Requirements:  * Must be able to stand or sit for more than 8 hours per day.  * Must be able to use an elevator or walk up & down stairs.  * Must be able to lift up to 40 pounds and carry up to 10 feet.  * Must be able to routinely grasp or handle objects, use finger dexterity, bend elbows/knees and reach above and below shoulders.  * Must be able to read and interpret handwritten and typewritten print.  * Must be able to communicate by voice and detect sound by ear.  * Must be able to perform duties in an indoor office or outdoor environment.  * Must be able to pass a criminal background investigation.  * Must undergo Urine Drug Screening (UDS).  * Must be a Citizen of the United States or legally authorized to work in the United States of America. Vighter LLC is an equal opportunity employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status, or any other characteristic protected by law. In accordance with recent Executive Orders (EO 14151, EO 14168 and EO 14173,) Vighter LLC is an equal opportunity employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status, or any other characteristic protected by law.   #IND2026 #vighter