Case Manager- Utilization Review Coordinator

Oklahoma Heart Hospital, LLC; Oklahoma City (OK); On-site; USD 75,000 - 95,000; Full time

Benefits offered by this job

Medical/Dental/Vision

401(k) with match

Disability coverage

EAP

PTO

Education opportunities

Job summary

Oklahoma Heart Hospital seeks an experienced registered nurse to lead utilization review and case management activities. You will coordinate patient care across admission through discharge, working with a multidisciplinary team to optimize outcomes and ensure payer compliance.

The role requires an RN with Oklahoma licensure and at least 3 years hospital-based experience in utilization/case management. CCM certification is encouraged, with strong computer skills a must.

Qualifications

• Graduate of an accredited school of nursing with current RN licensure.
• Minimum three years hospital nursing experience with utilization/case management.
• May pursue CCM certification; proficient in computer use.

Responsibilities

• Coordinate care for individual patients and populations to optimize outcomes.
• Lead multidisciplinary team activities within Utilization Review.
• Review admissions using Medicare and payer criteria.
• Identify inappropriate admissions and discuss alternatives with physicians.

Skills

Utilization review

Case management

Nursing

Education

Bachelor's/Master's in Nursing

Job description

Overview

Join Our Team at Oklahoma Heart Hospital (OHH)

ONE TEAM. ALL HEART. At OHH, we believe that patient care is truly at the heart of everything we do. Our dedicated team members are involved in every step of our patients' journeys, bringing hope, compassion, and healing to both patients and their families. Together with our physicians and caregivers, we're shaping the future of heart care in Oklahoma by serving the state and leading the nation.

Why You'll Love Working Here:

Comprehensive Benefits:

• Medical, Dental, and Vision coverage
• 401(k) plan with employer match
• Long-term and short-term disability
• Employee Assistance Programs (EAP)
• Paid Time Off (PTO)
• Extended Medical Benefits (EMB)
• Opportunities for continuing education and professional growth

Please note that benefits may vary by position, and some roles (like PRN, Flex, Float, etc.) may have exclusions. For eligible positions, benefits start on your first day!

We can't wait for you to join our heart-centered team!

Location: South Campus- 5200 E. I-240 Service Road, OKC OK 73132

Shift: Monday through Friday, 2pm to 10:30 pm.

No Weekends/ No Holidays

Position will require an RN, Registered Nurse Licensure.

Responsibilities

Responsible for comprehensive coordination of care and service of individual patients and/or patient populations, promoting effective utilization of resources, and assuming a leadership role on the multidisciplinary team to achieve patient and physician satisfaction and optimal outcomes. Responsible for all activities associated with the Utilization Review process. Must be able to work with all disciplines to meet patients' needs from admission through discharge. Will perform duties and responsibilities in a manner consistent with the mission and values of the Oklahoma Heart Hospital.

Performs admission review to assure patient is placed in correct level of care and concurrent or focused reviews using Medicare and payer specific criteria.

Demonstrates an ability to identify cases where admission criteria not met. Contacts physicians for additional information and suggests alternatives if admission/continued stay is not appropriate.

Knowledgeable on inpatient, observation and outpatient criteria.

Knowledgeable of billing, payer contracts, agreements and reimbursement issues for services provided to OHH patients.

Qualifications

Education: Graduate of an accredited school of nursing. Bachelors or Master's degree a plus.

Experience: Minimum of three (3) years hospital based nursing practice with experience in utilization/case management. Willing to pursue certification in Case Management (CCM). Proficient in computer usage.

Licensure/Certification: Registered Nurse with current Oklahoma licensure.

As part of our team, you are empowered to work collaboratively with our physicians and other caregivers, and play an integral role in setting the standard for excellence in patient care.

Every team member at OHH plays an integral role in our patients' experience. They are the reason OHH continues to serve the state and lead the nation. Be part of the future of cardiac care.