RN: Utilization Review & Case Management Lead

Oklahoma Heart Hospital, LLC; Oklahoma City (OK); On-site; USD 75,000 - 95,000; Full time

Benefits offered by this job

Medical/Dental/Vision

401(k) with match

Disability coverage

EAP

PTO

Education opportunities

Job summary

Oklahoma Heart Hospital seeks an experienced registered nurse to lead utilization review and case management activities. You will coordinate patient care across admission through discharge, working with a multidisciplinary team to optimize outcomes and ensure payer compliance.

The role requires an RN with Oklahoma licensure and at least 3 years hospital-based experience in utilization/case management. CCM certification is encouraged, with strong computer skills a must.

Qualifications

• Graduate of an accredited school of nursing with current RN licensure.
• Minimum three years hospital nursing experience with utilization/case management.
• May pursue CCM certification; proficient in computer use.

Responsibilities

• Coordinate care for individual patients and populations to optimize outcomes.
• Lead multidisciplinary team activities within Utilization Review.
• Review admissions using Medicare and payer criteria.
• Identify inappropriate admissions and discuss alternatives with physicians.

Skills

Utilization review

Case management

Nursing

Education

Bachelor's/Master's in Nursing

Job description

Oklahoma Heart Hospital seeks an experienced registered nurse to lead utilization review and case management activities. You will coordinate patient care across admission through discharge, working with a multidisciplinary team to optimize outcomes and ensure payer compliance.

The role requires an RN with Oklahoma licensure and at least 3 years hospital-based experience in utilization/case management. CCM certification is encouraged, with strong computer skills a must.