Medical Management (UM & CM) - Ramstein

$ by BFrench Consulting GmbH in Sinsheim, Apr 10
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BFrench Consulting, GmbH is a Germany-based Service-Disabled Veteran-Owned Small Business (SDVOSB), providing Professional Management and Health Care Consulting Solutions to Government Service Organizations.

Full Time Employees (40 Hrs / Week)
Ramstein Air Base, Germany
Starting date: May 2018

Medical Management:
Utilization Management (UM)
& Case Management (CM


The contract registered nurses shall establish and implement a local, on-site UM and CM program.

? Develop and maintain a comprehensive MM program for Military Health System (MHS) beneficiaries
? Serve as a liaison with higher headquarters, TRICARE Regional Offices (TROs), Accreditation Association for Ambulatory Health Care (AAAHC), professional organizations, and community health care facilities
? Conduct first level reviews for referrals
? Plan and prioritize MM activities to ensure identified patient needs are addressed promptly. Act as facilitator of professional and patient care activities
? Examine, assess, monitor, and evaluate patient care MHS with regard to medical necessity and the efficient and effective allocation of medical and non-medical resources
? Maintain open and professional communication and working relationships, demonstrating excellent customer service skills
? Attend and participate in meetings, professional staff conferences
? Develop program literature, presentations, and marketing materials as needed
? Responsible for creating, maintaining, and disposing of Government records
? .Provide excellent patient assessment skills

? Registered Nurses (RN), Baccalaureate of Science of Nursing (BSN) preferred, must have proof of graduation from an accredited educational institution. A Master‘s Degree is highly recommended
? Possess a valid unrestricted license to practice as a Registered Nurse in the United States. The professional license must allow the holder to legally and independently practice without the supervision of another licensed professional
? Current certification in cardiopulmonary resuscitation (CPR) Basic Life Support (BLS) is required
? Familiarity with quality improvement process is required.
? Comprehension of essential information systems such as the Composite Health Care System (CHCS) and familiarity with Microsoft Word, Excel, PowerPoint, and Access is highly desirable
? Work experience with the military health care system including TRICARE health benefits or work experience involving the principles of fee-for-services

? For Utilization Management:
o Six (6) years of broad based clinical nursing experience and previous experience in UM is preferred
o Must possess the necessary knowledge, skills and computer literacy to interpret and apply medical care criteria, such as InterQual or Milliman Ambulatory Care Guidelines
o Must possess experience in performing prospective, concurrent, and retrospective reviews to justify medical necessity for medical care
o Working knowledge of Ambulatory Procedure Grouping (APGs), Diagnostic Related Grouping (DRGs), International Classification of Diseases-Version 9 (ICD-9), and Current Procedural Terminology-Version 4 (CPT-4) coding
o Minimum of two (2) years of recent experience (within the last four (4) years) in nursing

? For Case Management:
o Minimum of two (2) years recent experience (within the last four (4) years) in professional nursing or CM for adults, children, families, seniors, or groups
o Competency in performance of core activities of Case Management, i.e., patient advocacy, assessment, planning, implementation, coordination, monitoring, and evaluation
o Demonstrate expertise in resolving complicated healthcare, social, interpersonal, and financial patient situations
o Experience in program planning, implementation, and evaluation, and in conducting individual, family, group, and community assessments
o Demonstrate ability to communicate effectively both orally and in writing
o Knowledge of accreditation standards and privacy and confidentiality requirements, such as, AAAHC and HIPAA
o Knowledge of DoD, Federal, State, non-profit healthcare systems and organizations, to include DoD Tri-Service Military Healthcare Systems, TRICARE purchased care system, Medicare, Medicaid, Veterans Administration, Public Health Department, Regional and local support services

Any interested persons in this position should submit resume, cover letter, and any applicable proof of certification highlighting the above qualifications to Ms. Anna Hug, Business Manager via E-Mail to

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