Utilization Management Nurse, RN

Job not on LinkedIn

🔥 12 hours ago

🌪️ Oklahoma – Remote

🌪️ Oklahoma – Remote

⏰ Full Time

🟢 Junior

🟡 Mid-level

👻 Ghost score 12%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

Apply Now

Find Similar Remote Jobs

Set Up Email Alert For New Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

Saint Francis Health System

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1960

🏥 Healthcare

🏨 Hospitality

🤝 Non-profit

Healthcare • Hospitality • Non-profit

Saint Francis Health System is a healthcare organization based in Tulsa, Oklahoma that operates multiple hospitals, clinics, specialty centers, and support services across eastern Oklahoma. It offers a broad range of clinical services including primary care, cardiology and heart & vascular services, cancer care, neurosciences, behavioral and mental health, orthopedic care, women’s and pediatric care, imaging & lab services, rehabilitation, hospice and home care, trauma services, and specialty institutes (e. g. , Heart and Vascular Institute, Trauma Institute, Children’s Hospital). The system provides urgent care, virtual urgent care, in-home urgent care via DispatchHealth, emergency care including a pediatric emergency center, and many outpatient clinics and diagnostic services. It also supports physician services, medical education (OSU residency partnership), community outreach, financial assistance, patient billing/price transparency, charitable giving, and volunteer programs. The organization lists locations, patient resources, MyChart patient portal, and administrative functions (careers, supplier info, privacy and compliance notices).

📋 Description

• Provide administrative and clinical support to the hospital and treatment teams during patient reviews • Support patient placement in various levels of care and receipt of necessary services • Communicate reimbursement issues to providers • Participate in treatment teams, the Patient Care Committee, and the Utilization Review Staff Committee • Gather, prepare, and supply clinical/treatment information required for authorization within review time requirements • Provide eligibility, benefits, and level-of-care criteria information • Assist with discharge planning as needed • Identify and report quality-improvement triggers • Review patient eligibility and benefits to validate accurate level-of-care utilization • Investigate and prepare insurance appeals related to medical necessity or other treatment issues • Participate in quality-of-care and utilization-management process improvement • Assist with developing Utilization Review Staff Committee process-improvement goals • Provide staff education supporting utilization-review goals

🎯 Requirements

• Prior Utilization Management experience is preferred • Completed the basic professional curricula of a school of nursing approved and verified by a state board of nursing, holding or entitled to hold a diploma or degree, or a Master’s degree in Nursing • Valid multi-state or State of Oklahoma Registered Nurse License • Minimum 2 years of related experience in an acute care setting • Ability to organize and prioritize work effectively and efficiently • Effective interpersonal, written, and oral communication skills • Ability to analyze data to discover facts or develop knowledge, concepts, or interpretations • Detail-oriented ability in examining numerical data • Ability to synthesize clinical case data into concise summaries • Working knowledge of Microsoft Word, Excel, and Access • Ability to work directly with patients, customers, healthcare professionals, and staff • Ability to work with individuals at Director level or above

🏖️ Benefits

• Full-time schedule • Day shift schedule • Saturday, Sunday and Monday, 6:45am–7:15pm