Remote RN Case Manager - Utilization Review (PRN)

OU Health; Kansas; Remote; USD 70,000 - 100,000; Full time

Benefits offered by this job

PTO

401(k)

Medical insurance

Dental plan

Job summary

OU Health is seeking a Case Manager, RN - Utilization Review (PRN) to evaluate medical necessity and ensure appropriate care with payors and providers. This role requires cooperation with patients and families, adherence to HIPAA, and strong problem-solving capabilities.

Responsibilities include coordinating with health teams, educating patients about care status, and driving quality improvements while meeting regulatory and cost-containment goals. Prior UR experience is a plus.

Qualifications

• Bachelor’s degree in nursing required.
• Minimum 3 years of nursing experience with care management preferred.
• Current RN license (OK state or multistate compact) required.
• Experience in utilization review and regulatory guidelines is preferred.
• Strong communication and leadership skills in a healthcare setting.

Responsibilities

• Assess patients' health status and care needs using evidence-based criteria.
• Coordinate with interdisciplinary team, payors, patients, and families to obtain authorization and reimbursement.
• Educate patients and families about care status and regulatory expectations.
• Lead care management meetings and interdisciplinary rounds; participate in quality initiatives.
• Maintain HIPAA compliance in a work-from-home environment and protect patient information.

Skills

Regulatory knowledge

Communication skills

Leadership

Organizational skills

Problem-solving

HIPAA/PHI compliance

EHR/care management software

Education

Bachelor's Degree in Nursing

Tools

EHR systems

Job description

OU Health is seeking a Case Manager, RN - Utilization Review (PRN) to evaluate medical necessity and ensure appropriate care with payors and providers. This role requires cooperation with patients and families, adherence to HIPAA, and strong problem-solving capabilities.

Responsibilities include coordinating with health teams, educating patients about care status, and driving quality improvements while meeting regulatory and cost-containment goals. Prior UR experience is a plus.