RN Case Manager – Utilization Review

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🌪️ Oklahoma – Remote

🌪️ Oklahoma – Remote

⏱ Part 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 to healthcare and community organizations • 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 timely 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 to other healthcare organizations according to policies and applicable regulations • Advise physicians on discharge planning, medical-record documentation, resource utilization, and reimbursement issues • Maintain knowledge of CMS, Medicare/Medicaid, managed-care, payer regulations, and benefit limits • Educate patients, families, and healthcare professionals about payer regulations • 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 • Work collaboratively with patients, families, physicians, hospital staff, and external agencies

🎯 Requirements

• 2 years of experience in a clinical setting, such as home health, inpatient, physician office, or clinic • Current RN licensure in Oklahoma or a current multistate license from an eNLC member state • BLS certification issued by the American Red Cross or American Heart Association within 30 days of hire • Excellent interpersonal communication and collaboration skills • Computer experience • Experience with managed care and payer/provider requirements • Bachelor of Science in Nursing • Case Management Certification

🏖️ Benefits

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