- US Tech Solutions (May, OK)
- …HAVE MANAGED CARE exp and Medicare/Medicaid knowledge. . MUST HAVE UM experience, inpatient utilization management review . . MUST HAVE 1 YEAR OF UTILIZATION ... policy, regulatory and accreditation guidelines. . Responsible for the review and evaluation of clinical information and documentation. ..... 1+ years of inpatient hospital experience . Registered Nurse in state of residence . Must have prior… more
- Saint Francis Health System (OK)
- …reimbursement issues and participate in treatment teams, Patient Care Committee, and the Utilization Review Staff Committee by providing data and contributing to ... levels of care and receipt of necessary services. The Utilization Management (UM) Registered Nurse will communicate...nor does it prohibit the assignment of additional duties. Utilization Review Management - Yale Campus Location:… more
- Cognizant (Oklahoma City, OK)
- …background - Registered Nurse (RN) + 2-3 years combined clinical and/or utilization management experience with managed health care plan + 3 years' experience in ... Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact by performing advanced...as well as timely filing deadlines and processes. + Review clinical denials including but not limited to referral,… more
- CenterWell (Oklahoma City, OK)
- …actual and proposed medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part of a team that ... RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity + Ability to work… more
- SSM Health (OK)
- …will provide cross coverage for MO / WI/ OK admissions. Prior experience in Utilization Review is required. **Job Summary:** Evaluates the medical necessity and ... of team regarding opportunities for improvement in standard work. + Performs review of pre-admission, perioperative, and post operative surgical cases. + Performs… more
- Humana (Oklahoma City, OK)
- …Coordinator or discharge planner in an acute care setting + Previous experience in utilization management/ utilization review for a health plan or acute care ... our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination,… more
- Saint Francis Health System (Tulsa, OK)
- …Telemetry Units. Overflow of Surgical, ortho, neuro and hospice / comfort measures. Utilization of hands-on skills Play an important role in not only the patient's ... support and encouragement. Work closely with social work, case management, nurse navigators to provide information of discharge planning. Family oriented… more
- Evolent (Oklahoma City, OK)
- …the mission. Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior approvals. Tasks ... physician-developed medical policies, and clinical decision-making criteria sets. The Clinical Review Nurse serves as a member advocate, expediting care… more
- HCA Healthcare (Oklahoma City, OK)
- …have the opportunity to make a real impact. As an Operating Room Registered Nurse you can be a part of change. **Benefits** Oklahoma Surgicare, offers a total ... location._** It is an exciting time to be a nurse at HCA Healthcare! Come unlock your career potential...the instrument and equipment set-up for your OR, including utilization of preference cards and ability to anticipate your… more
- Saint Francis Health System (Muskogee, OK)
- …**to login and apply.** Full Time Nights **Registered Nurse Full-time ICU** **Adult Intensive Care Unit** **6-12 months ... Registered Nurse experience required** Staff floats to other areas as...goals. Facilitates patient discharge through timely, appropriate referrals and utilization of patient education resources, suitable to patient age… more
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