RN Case Manager - Utilization Review (PRN, Remote)

OU Health; Arkansas; Remote; USD 75,000 - 95,000; Full time

Job summary

OU Health is seeking a Case Manager, RN - Utilization Review (PRN) to evaluate medical necessity and authorize hospital stays or treatments. You will work with insurance companies, patients, and interdisciplinary teams to ensure appropriate care and reimbursement while maintaining HIPAA compliance in a work-from-home setup.

Requires a Bachelor of Science in Nursing and an active RN license (OK or compact). A minimum of 3 years nursing experience, with care management exposure, is preferred.

Qualifications

• Bachelor's Degree in Nursing required.
• 3+ years of nursing experience; care management preferred.
• Current RN license (OK State Board or multistate compact).

Responsibilities

• Assess patient health status and care needs using evidence-based criteria.
• Coordinate with care team, payors, patients for authorization and reimbursement.
• Educate patients and families on care plan and regulatory expectations.
• Ensure timely authorizations and adherence to HIPAA and privacy rules.
• Lead and participate in quality improvement and care conferences.
• Mentor new Utilization Review staff.

Skills

Regulatory knowledge

Communication

Leadership

Problem-solving

HIPAA compliance

Team collaboration

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 evaluate medical necessity and authorize hospital stays or treatments. You will work with insurance companies, patients, and interdisciplinary teams to ensure appropriate care and reimbursement while maintaining HIPAA compliance in a work-from-home setup.

Requires a Bachelor of Science in Nursing and an active RN license (OK or compact). A minimum of 3 years nursing experience, with care management exposure, is preferred.