Remote Pediatric Utilization Review Nurse

OU Health; United States; Remote; USD 75,000 - 105,000; Full time

Benefits offered by this job

Sign-on bonus up to $10,000

Job summary

OU Health seeks an experienced Utilization Review Nurse (RN) to support the Children’s Behavioral Health Center. The role involves evaluating medical necessity, coordinating with Payors, and ensuring appropriate hospital stay authorizations after fall 2026 start.

Levels I–III reflect increasing experience and education, with RN licensure required and a strong emphasis on regulation, documentation, and patient-centered care. Telework options may be available with secure PHI handling.

Qualifications

• Education and RN licensure required across levels I–III.
• Experience ranges from 0–5+ years with care management emphasis.
• Knowledge of CMS guidelines and payor contracts.

Responsibilities

• Assesses patients' health status and care needs using evidence-based criteria.
• Coordinates with payors, patients, families and providers for authorization and status.
• Educates patients and families about care plans and hospital stays.
• Facilitates communication among patients, providers and payors.
• Participates in quality improvement and regulatory compliance activities.

Skills

Regulatory knowledge

HIPAA compliance

Care management

EHR proficiency

Critical thinking

Communication skills

Problem solving

Education

Bachelor’s Degree in Nursing

Associate’s Degree in Nursing

Tools

EHR software

Care management software

Job description

OU Health seeks an experienced Utilization Review Nurse (RN) to support the Children’s Behavioral Health Center. The role involves evaluating medical necessity, coordinating with Payors, and ensuring appropriate hospital stay authorizations after fall 2026 start.

Levels I–III reflect increasing experience and education, with RN licensure required and a strong emphasis on regulation, documentation, and patient-centered care. Telework options may be available with secure PHI handling.