Utilization Management RN - Care Coordination Lead

CommunityCare, Inc.; Tulsa, Northern (OK, KY); Hybrid; USD 65,000 - 90,000; Full time

Job summary

CommunityCare, Inc. in Tulsa, OK is seeking a Registered Nurse to perform utilization review and coordinate care for high-risk members and populations served. The role collaborates with physicians, documents determinations, and supports care management initiatives across the health care continuum.

A Oklahoma RN license and acute care experience are preferred. Join a collaborative Utilization Management Team, participate in ongoing education, and ensure timely, quality patient care across

Qualifications

• Graduation from accredited School of Nursing.
• Current, active, unrestrictive RN license in Oklahoma.
• Three years acute care experience preferred.
• Two years population health experience preferred.
• Managed care experience a plus.

Responsibilities

• Performs utilization review of outpatient and ancillary services as well as inpatient and post-acute services when indicated.
• Determines medical necessity and appropriateness of services using clinical review criteria.
• Documents all review determinations and contacts providers and members according to established timeframes.
• Identifies and refers cases that do not meet established clinical criteria to the Medical Director.
• Identifies potential cases for Care Management programs and collaborates with physicians.
• Collaborates with physicians and other providers to facilitate provision of services throughout the health care continuum.
• Communicates appropriate information to other staff members as necessary/required.
• Participates in continuing education initiatives.
• Performs other duties as assigned.

Skills

Communication skills

Judgment and decision making

Organizational skills

Time management

Documentation skills

Community resources knowledge

Managed care knowledge

Education

RN license in Oklahoma

Graduation from accredited School of Nursing

Tools

Microsoft Office

Job description

CommunityCare, Inc. in Tulsa, OK is seeking a Registered Nurse to perform utilization review and coordinate care for high-risk members and populations served. The role collaborates with physicians, documents determinations, and supports care management initiatives across the health care continuum.

A Oklahoma RN license and acute care experience are preferred. Join a collaborative Utilization Management Team, participate in ongoing education, and ensure timely, quality patient care across