RN Case Manager - Utilization Review (PRN, Remote)

OU Health

Town of Texas (WI)

Remote

USD 85,000 - 100,000

Part time

3 days ago

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Benefits offered by this job

PTO

401(k)

Medical and dental plans

Job summary

OU Health is seeking a Case Manager, RN - Utilization Review (PRN) who evaluates medical necessity and coordinates authorizations for hospital stays and treatments. You will work with payors, patients, and interdisciplinary teams to ensure appropriate care while protecting PHI in a home-based setting.

Minimum 3 years of nursing experience with care management preferred; a BSN and RN license (OK or multi-state) are required.

Qualifications

Bachelor's degree in nursing required.
At least 3 years of nursing experience with care management preferred.
Current RN license (OK State Board or multistate compact).

Responsibilities

Conduct comprehensive patient assessments using evidence-based criteria.
Coordinate with care team, payors, patients and families to secure authorizations.
Educate patients and families about their stay and status per regulatory and financial expectations.
Coordinate and facilitate communication to optimize reimbursement outcomes.
Evaluate utilization criteria and payor platforms; escalate to leadership as needed.
Identify opportunities to improve efficiency and cost-effectiveness based on payor contracts.
Precept new UR care managers and participate in quality initiatives.
Maintain HIPAA-compliant home-work environment and participate in audits.