RN Case Manager: Utilization Review Lead

Oklahoma Heart Hospital, L.L.C.; Oklahoma City, Northern (OK, KY); Hybrid; USD 70,000 - 100,000; Full time

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

401(k) match

Long-term disability

Short-term disability

EAP

Paid time off

Extended medical benefits

Education opportunities

Job summary

Oklahoma Heart Hospital, L.L.C. in Oklahoma City seeks an experienced Registered Nurse to coordinate utilization review and case management within a multidisciplinary team.

Requires 3+ years hospital nursing with utilization/case management experience; Oklahoma RN licensure. Shift Monday–Friday, 2:00 pm–10:30 pm; no weekends or holidays. Join a heart-centered team dedicated to patient outcomes and payer collaboration.

Qualifications

• Graduate of an accredited school of nursing.
• 3+ years hospital based nursing practice with utilization/case management experience.
• Willing to pursue CCM certification (CCM).

Responsibilities

• Coordinate care and service for individual patients and populations.
• Lead utilization review process on the multidisciplinary team.
• Perform admissions reviews to ensure correct level of care and payer criteria.
• Identify cases where admission criteria are not met and discuss alternatives with physicians.
• Be knowledgeable about inpatient, observation, and outpatient criteria; understand billing and payer contracts.

Education

Graduate of an accredited school of nursing

3+ years hospital based nursing experience

CCM pursuit

Tools

Computer usage

Job description

Oklahoma Heart Hospital, L.L.C. in Oklahoma City seeks an experienced Registered Nurse to coordinate utilization review and case management within a multidisciplinary team.

Requires 3+ years hospital nursing with utilization/case management experience; Oklahoma RN licensure. Shift Monday–Friday, 2:00 pm–10:30 pm; no weekends or holidays. Join a heart-centered team dedicated to patient outcomes and payer collaboration.