PRN RN Case Manager - Utilization Review

OU Health; Missouri; Remote; USD 60,000 - 90,000; Part time

Benefits offered by this job

PTO

401(k)

Job summary

OU Health is seeking a Case Manager, RN - Utilization Review, PRN to evaluate medical necessity and secure authorizations. The role partners with payors, patients, and interdisciplinary teams to ensure appropriate care while safeguarding PHI in a home-based setting.

Requires a Bachelor's in Nursing, current RN license, and at least 3 years of nursing experience; strong regulatory knowledge and communication skills are essential. This PRN position offers flexible shifts and remote work options.

Qualifications

• RN with current license (Oklahoma or multistate compact) required.
• Minimum 3 years of nursing experience; care management experience preferred.

Responsibilities

• Assess patients' health status and care needs using evidence-based criteria.
• Coordinate with interdisciplinary team, payors, patients, and families for status and reimbursement.
• Educate patients and families on hospital stay and status.
• Facilitate communication to ensure timely authorizations and billing.
• Monitor utilization data and improve efficiency and reimbursement outcomes.
• Lead care management team meetings and participate in quality initiatives.
• Ensure compliance with HIPAA and regulatory requirements.

Skills

Communication skills

Leadership

Regulatory knowledge

HIPAA compliance

EHR proficiency

Critical thinking

Education

Bachelor's Degree in Nursing

Tools

Care management software

Electronic Health Records (EHR)

Job description

OU Health is seeking a Case Manager, RN - Utilization Review, PRN to evaluate medical necessity and secure authorizations. The role partners with payors, patients, and interdisciplinary teams to ensure appropriate care while safeguarding PHI in a home-based setting.

Requires a Bachelor's in Nursing, current RN license, and at least 3 years of nursing experience; strong regulatory knowledge and communication skills are essential. This PRN position offers flexible shifts and remote work options.