Utilization Review Nurse, Registered Nurse – Children's Behavioral Health Center

🔥 0 minutes ago

🌪️ Kansas, Oklahoma, +2 more states – Remote

🌪️ Kansas – Remote 🌪️ Oklahoma – Remote 🏰 Missouri – Remote 🤠 Texas – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

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OU Health

WebsiteLinkedInAll Job Openings

10,000+ employees

🏥 Healthcare

⚕️ Healthcare Insurance

Healthcare • Healthcare Insurance

OU Health is a comprehensive healthcare provider offering a wide range of medical services including pediatric care, cancer care, diabetes care, emergency care, and specialized services for adults and children. Located in Oklahoma, OU Health operates multiple facilities such as the Oklahoma Children's Hospital and the Stephenson Cancer Center. Known for its advanced scientific research and quality care, the organization prides itself on being recognized for excellence in areas like pediatric cardiology and heart surgery. As part of its commitment to medical excellence, OU Health also focuses on medical education and research, helping to train the next generation of healthcare professionals.

📋 Description

• Conduct comprehensive assessments of patients' health status, medical history, and ongoing care needs using evidence-based criteria tools • Coordinate with interdisciplinary healthcare teams, payors, patients, and families to ensure appropriate status and financial reimbursement • Educate patients and families regarding healthcare stays and appropriate status • Facilitate communication among patients, families, healthcare providers, and payors • Evaluate clinical information and healthcare utilization patterns • Identify opportunities to improve efficiency and cost-effectiveness based on payor contracts and regulatory guidelines • Advocate for appropriate patient status while adhering to regulatory and reimbursement criteria • Collaborate with insurance providers and stakeholders to secure timely authorization and coverage for hospital care and treatment • Monitor financial outcomes and processes to identify improvement areas • Participate in quality improvement initiatives and interdisciplinary care conferences • Ensure compliance with federal, state, local, and accreditation requirements • Implement strategies to minimize readmissions and prevent financial complications • Maintain a HIPAA-compliant work-from-home environment protecting patient PHI • Maintain continuing education and participate in quality audit reviews • Perform other duties as assigned

🎯 Requirements

• Associate's Degree in Nursing required for Level I; Bachelor's Degree in Nursing required for Levels II and III • Level I: 0–3 years of RN experience required; care management experience preferred • Level II: at least 3 years of Care Management experience required • Level III: 5 or more years of Care Management experience required • Current Registered Nurse license issued by the Oklahoma State Board of Nursing or current multistate compact Registered Nurse license (eNLC) • Expertise in regulatory requirements for utilization nursing/care management • Strong communication, interpersonal, and leadership skills • Detailed-oriented with excellent organizational skills • Strong assessment, critical-thinking, and problem-solving skills • Strong knowledge of healthcare regulations, including CMS guidelines and payor contractual agreements • Understanding of utilization management principles and nursing care management responsibilities • Ability to serve as liaison among patients, families, payors, and healthcare providers • HIPAA compliance in a work-from-home environment to safeguard PHI • Proficiency with electronic health records (EHR) and care management software • Must live and work full-time in Arkansas, Kansas, Missouri, Oklahoma, or Texas, or plan to relocate to one of these states before employment begins • Must provide secure internet and cellular phone services • Successful fingerprint-based background check required for positions supporting Oklahoma Children's OU Health Behavioral Health Center

🏖️ Benefits

• Comprehensive benefits package • PTO • 401(k) • Medical plans • Dental plans • Clinical and non-clinical opportunities to further your career • Reasonable accommodations for qualified individuals with disabilities