- US Tech Solutions (May, OK)
- …MUST HAVE MANAGED CARE exp and Medicare/Medicaid knowledge. . MUST HAVE UM experience, inpatient utilization management review . . MUST HAVE 1 YEAR OF ... policy, regulatory and accreditation guidelines. . Responsible for the review and evaluation of clinical information and documentation. ....UTILIZATION MANAGEMENT EXP, pref. knowledge of Milliman/MCG. . MUST HAVE… more
- CenterWell (Oklahoma City, OK)
- …RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity + Ability ... Therapy, DME, Cardiac or Orthopedic procedures + Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/Medicare… more
- CenterWell (Oklahoma City, OK)
- …+ Prior clinical experience, managed care experience, DME, Florida Medicaid **OR** utilization management experience + Demonstrates Emotional Maturity + Ability ... Orthopedic procedures + Compact License preferred + Previous experience in utilization management within Insurance industry + Previous Medicare… more
- Centene Corporation (Oklahoma City, OK)
- …and substance abuse preferred. Knowledge of mental health and substance abuse utilization review process preferred. Experience working with providers and ... 28 million members as a clinical professional on our Medical Management /Health Services team. Centene is a diversified, national organization offering competitive… more
- Sharecare (Oklahoma City, OK)
- …appropriate resource utilization and desired clinical outcomes. The Disease Management Nurse is also responsible during their interactions with participants ... learn more, visit www.sharecare.com . **Job Summary:** The Disease Management Nurse has the responsibility for supporting...and to take the pre and post tests to review competency during orientation. Yearly competency tests are required… more
- Veterans Affairs, Veterans Health Administration (Muskogee, OK)
- …possesses an intimate knowledge of the internal referral care process, clinical review criteria, utilization management standards, clinical documentation ... Veterans Act of 2016. Responsibilities The Community Care (CC) Coordinator Registered Nurse (RN) is responsible for executing a streamlined approach to receiving,… more
- CVS Health (Oklahoma City, OK)
- …Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers flexible medical management ... Pharmacy or Oncology.** **Preferred Qualifications** + 1+ years' Case Management experience or discharge planning, nurse navigator...lower levels of care. + 1+ years' experience in Utilization Review . + CCM and/or other URAC… more
- Saint Francis Health System (Tulsa, OK)
- …their family-providing support and encouragement. Work closely with social work, Case Management , Nurse Navigators to provide information of discharge planning. ... of Surgical, Ortho, Neuro and Hospital / Comfort measures. Utilization of hands-on skills. Play an important role in...improving the care for Health System Elders is a nurse driven program designed to help hospital and health… more
- Evolent (Oklahoma City, OK)
- …quality and cost effective care delivery. **What You'll Be Doing:** + Performs utilization review of outpatient procedures and ancillary services. + Fulfills on ... for the mission. Stay for the culture. **What You'll Be Doing:** The Nurse Reviewer is responsible for performing precertification and prior approvals. Tasks are… more
- Prime Therapeutics (Oklahoma City, OK)
- …of post-degree clinical experience. + Experience in managed care, specialty drugs, care management and utilization review . + Meets Credentialing criteria. + ... drives every decision we make. **Job Posting Title** Infusion Referral Nurse - REMOTE **Job Description** Under supervision, is responsible for performing referral… more