Responsible for clinical review of utilization requests, the full-time Oklahoma Licensed Utilization Management RN will assess and implement coordination of care opportunities for high-risk members while working remotely as part of the Utilization Management Team. Key responsibilities: Perform utilization review of outpatient, ancillary, inpatient, and post-acute services Determine medical necessity and appropriateness of services using clinical review criteria Collaborate with physicians and providers to facilitate service provision throughout the health care continuum Required qualifications: Current, active, unrestrictive license to practice as a Registered Nurse in the State of Oklahoma Graduation from an accredited School of Nursing Three years of acute care experience preferred Two years of experience working with population health preferred Knowledge of managed care and associated group benefit plans
Oklahoma Licensed Utilization Management RN in workfromhome at Unknown Company
This position is listed as full time and able to be worked remotely.