RN Case Manager – Utilization Review

🔥 2 minutes ago

🌪️ Oklahoma – Remote

🌪️ Oklahoma – Remote

⏰ Full Time

🟢 Junior

🟡 Mid-level

👔 Manager

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INTEGRIS Health

WebsiteLinkedInAll Job Openings

10,000+ employees

🏥 Healthcare

⚕️ Healthcare Insurance

💊 Pharmaceuticals

Healthcare • Healthcare Insurance • Pharmaceuticals

INTEGRIS Health is the largest Oklahoma-owned health care system and one of the state's largest private employers. It operates hospitals, rehabilitation centers, physician clinics, mental health facilities, fitness centers, independent living centers, home health agencies, and urgent cares throughout much of Oklahoma. Since the late 1950s, INTEGRIS Health has built a community of health care providers to serve Oklahoma families. Their mission is to partner with people to live healthier lives, offering quality and compassionate health care, as well as career opportunities for those in the health sector.

📋 Description

• Complete comprehensive assessments of patients’ clinical, psychological, and financial needs • Recommend and coordinate timely transfers to appropriate levels of care • Develop, implement, evaluate, and revise discharge plans, including referrals • Communicate discharge care plans and changes to patients, families, and healthcare professionals • Assist physicians and hospital staff with resource utilization and timely discharge planning • Coordinate services between hospital departments to facilitate patient discharge • Conduct concurrent reviews of patient records • Apply utilization criteria to determine appropriate resource utilization • Notify internal and external contacts about utilization issues affecting patient care or reimbursement • Facilitate patient transfers according to hospital policies and applicable regulations • Advise physicians on discharge planning, documentation, resource utilization, and reimbursement • Manage established pathways to enhance clinical effectiveness and resource management • Maintain knowledge of CMS, Medicare, Medicaid, managed care, payer regulations, and benefit limits • Educate patients, families, and healthcare professionals about payer regulations and benefits • Develop knowledge of hospital and community resources and facilitate appropriate levels of care • Identify opportunities to reduce care-management costs without affecting quality or outcomes • Collect and record data for utilization and Quality Improvement reporting • Collaborate with patients, families, physicians, hospital staff, and other care organizations

🎯 Requirements

• 2 years experience in a clinical setting, such as home health, inpatient, physician office, or clinic • BLS (Basic Life Support) issued by American Red Cross or American Heart Association within 30 days of hire • Current Registered Nurse (RN) licensure in the State of Oklahoma or current multistate license from a Nurse Licensure Compact (eNLC) member state • Excellent interpersonal communication and collaboration skills • Computer experience • Effective communication in English, verbal and written • Current Oklahoma State Driver's License • Driving record acceptable to the employer's insurance carrier • Experience with managed care and payer/provider requirements preferred • Bachelor's of Science in Nursing preferred • Case Management Certification preferred

🏖️ Benefits

• Front-loaded PTO • Medical benefits through the extensive INTEGRIS Health network • Financial assistance for continued education • 24/7 mental health support