Remote RN Utilization Review Case Manager (PRN)

OU Health; Northern (KY); Hybrid; USD 55,000 - 83,000; Part time

Job summary

OU Health is seeking a Case Manager, RN – Utilization Review (PRN) to work remotely from approved states AR, KS, MO, OK or TX. You will assess medical necessity, coordinate with payors and care teams, educate patients, and ensure appropriate hospital utilization and reimbursement.

The role requires a Bachelor’s in Nursing, an active RN license, and at least 3 years in nursing with care management. Strong communication and regulatory knowledge are essential for success.

Qualifications

• Bachelor's Degree in Nursing required.
• At least 3 years of Nursing experience with care management preferred.
• Current RN license (OK eNLC or state board).
• Strong communication, interpersonal, and leadership abilities.
• Knowledge of CMS guidelines and payor contractual agreements.

Responsibilities

• Assess patients' health status, medical history, and ongoing care needs using evidence-based criteria.
• Coordinate with interdisciplinary team, payors, patients, and families to ensure appropriate status and reimbursement.
• Educate patients and families regarding care stay and compliance with regulatory and financial expectations.
• Coordinate communication among patients, families, providers, and payors to optimize reimbursement outcomes.
• Support regulatory compliance and participate in quality improvement activities.

Skills

Regulatory knowledge

CMS guidelines

HIPAA compliance

EHR proficiency

Care management

Education

Bachelor's degree in Nursing

Tools

EHR systems

Care management software

Job description

OU Health is seeking a Case Manager, RN – Utilization Review (PRN) to work remotely from approved states AR, KS, MO, OK or TX. You will assess medical necessity, coordinate with payors and care teams, educate patients, and ensure appropriate hospital utilization and reimbursement.

The role requires a Bachelor’s in Nursing, an active RN license, and at least 3 years in nursing with care management. Strong communication and regulatory knowledge are essential for success.