Top 21 Utilization review nurse Jobs in Tinker Afb Ok

RN Claims Review and Utilization Management
MedTrust LLC —Oklahoma City, OK
- Microsoft Word
- Nursing
- RN License
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Case Manager (SW / RN) PRN
SSM Health Rehabilitation Hospital – Oklahoma City —Oklahoma City, OK
- $40 an hour
- Weekends as needed
- Hospital
- Inpatient
- Mid-level
- Opportunities for advancement
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RN Case Manager - Baptist Case Management
INTEGRIS Health —Oklahoma
- Full-time
- Nursing
- RN License
- Hospital
- Health insurance
- Paid time off
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16h
Senior Review Coordinator (Oncology) - Utilization Management (RN)
Telligen —Oklahoma City, OK
- Email
- Hybrid work
- Nursing
- RN License
- Research
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RN Case Manager - Utilization Review Part Time
INTEGRIS Health —Oklahoma City, OK
- Part-time
- Nursing
- RN License
- Hospital
- Health insurance
- Paid time off
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5d
Part-time RN Nurse Navigator - Meinders Center for Movement Disorders
Mercy —Oklahoma City, OK
- Part-time
- Nursing
- RN License
- Hospital
- Health insurance
- Dental insurance
Complex Care Manager - Readmissions
OU Health —Oklahoma City, OK
- Full-time
- Nursing
- RN License
- Hospital
- Relocation assistance
- Health insurance
RN-Community Care Coordinator, Nursing Operations
US Veterans Health Administration —Oklahoma City, OK
- $75,016 - $139,502 a year
- Online Application
- Background check
- Nursing
- Doctoral degree
- Paid holidays
- Dental insurance
RN Case Manager - Utilization Review
INTEGRIS Health —Oklahoma City, OK
- Full-time
- Nursing
- RN License
- Hospital
- Health insurance
- Paid time off
Quick Apply
9d
RN Case Manager - Integris Edmond
INTEGRIS Health —Edmond, OK
- Full-time
- Nursing
- RN License
- Hospital
- Health insurance
- Paid time off
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RN Case Manager - South Case Management
INTEGRIS Health —Oklahoma City, OK
- Full-time
- Nursing
- RN License
- Hospital
- Health insurance
- Paid time off
Quick Apply
9d
Registered Nurse (Weekend Supervisor
Midwest City Post Acute & Rehab —Oklahoma City, OK
- $38 - $42 an hour
- Part-time
- Nursing
- Patient monitoring
- RN License
Quick Apply
7d
LPN Medical Records Specialist
A Path of Care Home Health —Oklahoma City, OK
- Full-time
- Nursing
- Mid-level
- Office
- Paid holidays
- Disability insurance
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2d
Utilization Management Coordinator
Saint Francis Hospital, Inc. —Oklahoma City, OK
- Part-time
- Microsoft Word
- LMFT
- Nursing
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1d
Clinical Appeals & Grievances Nurse Reviewer
Tanaq Support Services LLC —United States
- Weekends as needed
- Microsoft Word
- Nursing
- Microsoft Excel

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Case Manager (RN) - Full-Time
OhioHealth Rehabilitation Hospital —Columbus, OH
Current Licensure per state guidelines in clinical or related discipline OR a Bachelor's or Master's in a health or human services discipline.
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RN Claims Review and Utilization Management

MedTrust LLC -
Oklahoma City, OK

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Job Details

Qualifications

Utilization review
RN License
Health insurance knowledge
Case management
Utilization management
Resource utilization in healthcare

Full Job Description

The utilization review and management (UM) component program ensures that external healthcare services provided across MedTrust/MedHealth contracted facilities are medically necessary, clinically appropriate, evidence-based, and delivered at the appropriate level of care, while supporting regulatory compliance and organizational risk management. The Joint Commission Compliance component ensures MedTrust stays complaint with applicable Joint Commission (JC) standards. MedTrust proudly holds the Gold Seal of Approval from the Joint Commission, recognizing our commitment to quality, safety, and excellence in healthcare staffing. This position ensures that MedTrust/MedHealth is fully compliant in both areas. These two components are referred to below as UMJC.

Essential Functions:

Oversee UMJC: Handle the utilization review and management process to ensure the appropriate and cost-effective use of healthcare resources. This includes evaluating treatment plans and ensuring compliance with regulatory requirements. Ensure compliance with JC standards, including file reviews, monthly safety plans and uploading data to the JC web page. This will include assisting with the logging and documentation of claims along the process chain.
Collaboration: Work closely with medical staff, case managers, and other healthcare professionals to assess the medical necessity of treatments and coordinate care effectively
Data Analysis: Analyze utilization data and trends to identify opportunities for improving efficiency and reducing unnecessary costs. This involves monitoring the performance of healthcare providers and implementing corrective action plans as needed
Documentation and Compliance: Maintain accurate documentation of all UMJC activities, ensuring compliance with organizational policies and regulatory requirements. This includes collaborating with hospitals and providers and resolving any utilization-related issues
Timeliness: Ensure that claims received are accurately logged and reviewed within seven (7) days of receipt and forwarded promptly to the next step in the process to ensure all claims are ultimately paid timely. It will be this person’s responsibility to notify appropriate management if claims are not being timely received for processing.
Quality Improvement Initiatives: Participate in the development and implementation of quality improvement initiatives to enhance patient care outcomes and operational efficiency
Joint Commission (JC) Functions: Maintain accurate and up-to-date documentation and compliance records. Serves as the medical lead during joint commission surveys and audits, including preparation of staff and materials. Keeps up-to-date on JC requirements and rules.

Qualifications

Registered nurse with active, unincumbered nursing licensed in Oklahoma and willing and able to get licensed in other states where MedTrust/MedHealth do business. Master’s degree is preferred.
Relevant experience in utilization review, utilization management/case management is essential.
Prior experience with Joint Commission compliance is a plus.
3-5 years of healthcare experience required.

Knowledge and Skills

Analytical Skills: Strong analytical and problem-solving skills to assess data and make informed decisions regarding patient care and resource utilization
Communication Skills: Excellent communication and interpersonal skills to collaborate effectively with healthcare teams and patients
Knowledge of Regulations: Familiarity with healthcare regulations, insurance policies, and quality improvement processes is crucial for success in these roles
Knowledge of Joint Commission: Familiarity with joint commission requirements and duties.
Working knowledge of and familiarity with Microsoft Word and Excel.
Strong organization skills, with ability to work in fast paced environment.

Working Conditions and Environment

Must pay attention to detail-visual & mental
Must be able to multi-task
Ability to work independently without direct supervision
Ability to perform under stress
Ability to work with individuals at all levels of the organization to foster teamwork
While varied hours are required occasionally, normal office hours are 8 am – 5 pm with one hour for lunch
This is an in-office, no remote work capability position

Travel

Some travel may be required, but should be minimal and notice will be provided if necessary

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utilization review nurse jobs in tinker afb ok

RN Claims Review and Utilization Management

Case Manager (SW / RN) PRN

RN Case Manager - Baptist Case Management

Senior Review Coordinator (Oncology) - Utilization Management (RN)

RN Case Manager - Utilization Review Part Time

Part-time RN Nurse Navigator - Meinders Center for Movement Disorders

Complex Care Manager - Readmissions

RN-Community Care Coordinator, Nursing Operations

RN Case Manager - Utilization Review

RN Case Manager - Integris Edmond

RN Case Manager - South Case Management

Registered Nurse (Weekend Supervisor

LPN Medical Records Specialist

Utilization Management Coordinator

Clinical Appeals & Grievances Nurse Reviewer

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