RN Case Manager – Utilization Review

Jobtailor; Oklahoma City (OK); On-site; USD 65,000 - 90,000; Full time

Job summary

Jobtailor is seeking a Nurse Case Manager in Oklahoma for discharge planning and care coordination. You will assess patients, coordinate transfers, and develop optimized discharge plans in collaboration with physicians and care teams.

Requirements include an RN license in Oklahoma or multistate, BLS, and strong communication skills. Experience with managed care and payer regulations is preferred. This is a full-time on-site role supporting efficient patient transitions.

Qualifications

• 2 years of clinical experience in home health, inpatient, physician office, or clinic.
• Current BLS certification from ARC or AHA within 30 days of hire.
• Active Oklahoma RN license or multi-state eNLC license.
• Excellent interpersonal communication and collaboration skills.
• English verbal and written communication proficiency.
• Valid Oklahoma driver’s license with acceptable driving record.
• Experience with managed care and payer/provider requirements preferred.
• BSN preferred.
• Case Management Certification preferred.

Responsibilities

• Complete comprehensive assessments of patients’ clinical, psychological, and financial needs.
• Recommend and coordinate timely transfers to appropriate levels of care.
• Develop, implement, evaluate, and revise discharge plans, including referrals.
• Communicate discharge care plans and changes to patients, families, and healthcare professionals.
• Assist physicians and hospital staff with resource utilization and timely discharge planning.
• Coordinate services between hospital departments to facilitate patient discharge.
• Apply utilization criteria to determine appropriate resource utilization.
• Notify internal and external contacts of utilization issues affecting patient care or reimbursement.
• Advise physicians on discharge planning, documentation, resource utilization, and reimbursement.

Skills

Interpersonal communication

Collaboration

Verbal communication

Written communication

Computer skills

English proficiency

Driver’s license

Managed care

Education

BSN

Case Management Certification

Tools

Computer Experience

Job description

• Complete comprehensive assessments of patients’ clinical, psychological, and financial needs
• Recommend and coordinate timely transfers to appropriate levels of care
• Develop, implement, evaluate, and revise discharge plans, including referrals
• Communicate discharge care plans and changes to patients, families, and healthcare professionals
• Assist physicians and hospital staff with resource utilization and timely discharge planning
• Coordinate services between hospital departments to facilitate patient discharge
• Conduct concurrent reviews of patient records
• Apply utilization criteria to determine appropriate resource utilization
• Notify internal and external contacts of utilization issues affecting patient care or reimbursement
• Facilitate patient transfers in accordance with hospital policies and state and federal guidelines
• Advise physicians on discharge planning, documentation, resource utilization, and reimbursement
• Manage established care pathways to enhance clinical effectiveness and resource management
• Maintain knowledge of CMS, Medicare, Medicaid, managed care, payer regulations, and benefit limits
• Educate patients, families, and healthcare professionals regarding payer regulations
• Identify appropriate hospital and community resources and levels of care
• Identify cost-reduction opportunities without compromising quality or outcomes
• Collect and record data for utilization and Quality Improvement reporting
• Collaborate with patients, families, physicians, hospital staff, and care agencies

Requirements

• 2 years of experience in a clinical setting, such as home health, inpatient, physician office, or clinic
• Current BLS certification issued by the American Red Cross or American Heart Association within 30 days of hire
• Current Registered Nurse licensure in Oklahoma or a current multistate license from an eNLC member state
• Excellent interpersonal communication and collaboration skills
• Computer experience
• Effective verbal and written communication in English
• Current Oklahoma State Driver’s License
• Driving record acceptable to the employer’s insurance carrier
• Experience with managed care and payer/provider requirements preferred
• Bachelor of Science in Nursing preferred
• Case Management Certification preferred

Core Competencies

Demonstrates expertise in patient assessment, discharge planning, and resource utilization while ensuring compliance with CMS, Medicare, and Medicaid regulations. Strong ability to communicate effectively with patients, families, and healthcare professionals to facilitate timely and efficient care transitions.

Highest-signal resume keywords

• Patient Assessment
• Discharge Planning
• Resource Utilization
• BLS Certification
• Registered Nurse Licensure

ATS Optimization Keywords

Hard Skills

• Clinical Assessment
• Discharge Planning
• Utilization Review
• Data Collection
• Quality Improvement Reporting

Soft Skills

• Interpersonal Communication
• Collaboration
• Effective Verbal Communication
• Written Communication

Certifications & Qualifications

• BLS Certification
• Case Management Certification

Industry Keywords

• CMS Regulations
• Medicare
• Medicaid
• Managed Care
• Payer Regulations

Tools & Technologies

• Computer Experience