Remote RN Case Manager - Utilization Review (PRN)

OU Health; Oklahoma; Remote; USD 60,000 - 80,000; Part time

Benefits offered by this job

PTO

401(k)

Medical plan

Dental plan

Job summary

OU Health is seeking a Case Manager, RN for Utilization Review on a PRN basis. The role focuses on evaluating medical necessity, coordinating with payors and providers, and ensuring appropriate care while maintaining HIPAA compliance, even in a remote setup.

The candidate will work with the Utilization Review team to optimize authorization processes, educate patients, and participate in quality improvement and interdisciplinary rounds.

Qualifications

• Bachelor's Degree in Nursing required.
• RN License in OK or a compact state.
• At least 3 years of nursing experience; care management preferred.
• Utilization Review experience preferred; CMS regulatory knowledge is a plus.

Responsibilities

• Conduct comprehensive assessments of patients' health status and care needs.
• Coordinate with interdisciplinary team, payors, patients, and families for status and reimbursement.
• Educate patients and families about care plans and regulatory expectations.
• Facilitate timely authorization of services and coverage for hospital care/treatment.
• Monitor outcomes and escalate issues to leadership for process improvements.
• Participate in quality improvement activities and care conferences.
• Maintain HIPAA-compliant environment when working remotely.

Skills

Regulatory compliance

Leadership

Communication

HIPAA knowledge

EHR proficiency

Care management

Problem-solving

Education

Bachelor's Degree in Nursing

Tools

EHR software

Job description

OU Health is seeking a Case Manager, RN for Utilization Review on a PRN basis. The role focuses on evaluating medical necessity, coordinating with payors and providers, and ensuring appropriate care while maintaining HIPAA compliance, even in a remote setup.

The candidate will work with the Utilization Review team to optimize authorization processes, educate patients, and participate in quality improvement and interdisciplinary rounds.