- CVS Health (Oklahoma City, OK)
- …And we do it all with heart, each and every day. **Position Summary:** The ** Utilization Management Clinical Nurse Consultant - Prior Authorization** ... internal and external constituents in the coordination and administration of the utilization /benefit management function. + Gathers clinical information and… more
- Cognizant (Oklahoma City, OK)
- …+ Educational background - Registered Nurse (RN) + 2-3 years combined clinical and/or utilization management experience with managed health care plan ... Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact by performing advanced...care revenue cycle or clinic operations + Experience in utilization management to include Clinical … more
- Humana (Oklahoma City, OK)
- …of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, ... determination of the appropriate courses of action. The Utilization Management Nurse 2 uses clinical knowledge, communication skills, and independent… more
- Centene Corporation (Oklahoma City, OK)
- …Knowledge of Medicare and Medicaid regulations preferred. Knowledge of utilization management processes preferred. **License/Certification:** LPN - Licensed ... be the one who changes everything for our 28 million members as a clinical professional on our Medical Management /Health Services team. Centene is a diversified,… more
- Evolent (Oklahoma City, OK)
- …for the mission. Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior approvals. ... physician-developed medical policies, and clinical decision-making criteria sets. The Clinical Review Nurse serves as a member advocate, expediting care… 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 ... self-insured clients. + Application and/or interpretation of applicable criteria and clinical guidelines, standardized care management plans, polices, procedures… more
- ERP International (Tinker AFB, OK)
- …algorithms, CM software, and databases for community resources. * Integrate CM and utilization management (UM) and integrating nursing case management with ... **Overview** ERP International, LLC is seeking a **Registered Nurse - Case Manager** for a full-time position...2 years as a BSN full time experience in clinical case management working with adults, children,… more
- Evolent (Oklahoma City, OK)
- …team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and Client policies and ... accomplishments. **What You Will Be Doing:** + Practices and maintains the principles of utilization management and appeals management by adhering to company… more
- SSM Health (Midwest City, OK)
- …care and prevention program in order to achieve exceptional clinical outcomes. **Job Responsibilities and Requirements:** PRIMARY RESPONSIBILITIES + Evaluates ... and communicates with patient/family/caregiver and appropriate nursing, physician, and care management staff. + Utilizes research and other forms of evidence to… more
- SSM Health (Oklahoma City, OK)
- …care and prevention program in order to achieve exceptional clinical outcomes. **Job Responsibilities and Requirements:** PRIMARY RESPONSIBILITIES + Evaluates ... and communicates with patient/family/caregiver and appropriate nursing, physician, and care management staff. + Utilizes research and other forms of evidence to… more
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