Utilization Review Nurse: Clinical Impact & Compliance

Oklahoma Arthritis Center; Edmond (OK); On-site; USD 65,000 - 90,000; Full time

Job summary

Oklahoma Arthritis Center is seeking a Medical Necessity Review Nurse to evaluate medical records and clinical data for medical necessity and cost-effective treatment planning. The role requires an Oklahoma RN license and at least 3 years of relevant clinical experience.

On-site position in Edmond, 8:00 a.m.–5:00 p.m. with potential travel for audits. The candidate will collaborate with providers and patients, document reviews, and ensure HIPAA compliance.

Qualifications

• Proven ability to provide excellent patient-focused service.
• Strong written and verbal communication skills.
• Knowledge of medical terminology and patient confidentiality.
• Familiarity with HIPAA laws and regulations.

Responsibilities

• Evaluate medical records and clinical data to determine medical necessity.
• Apply payer-specific guidelines to clinical reviews.
• Collaborate with patients, providers, and facilities for documentation.
• Prepare and document reviews and recommendations per policy.
• Participate in quality improvement initiatives and audits.

Skills

Customer service

Attention to detail

Communication skills

EMR proficiency

Microsoft Office

Education

RN license in Oklahoma

Tools

EMR software

Microsoft Office

Job description

Oklahoma Arthritis Center is seeking a Medical Necessity Review Nurse to evaluate medical records and clinical data for medical necessity and cost-effective treatment planning. The role requires an Oklahoma RN license and at least 3 years of relevant clinical experience.

On-site position in Edmond, 8:00 a.m.–5:00 p.m. with potential travel for audits. The candidate will collaborate with providers and patients, document reviews, and ensure HIPAA compliance.