Registered Nurse Utilization Review
About the role
Secures Patient-Centered Care: Ensures the right care at the right time by validating medical necessity, advocating for benefits, and coordinating smooth, safe transitions to reduce readmissions.
Maximizes Financial Health: Protects and maximizes organizational revenue by preventing claim denials, ensuring proper status designation for reimbursement, and managing the appeals process.
Drives Operational Efficiency: Streamlines hospital workflows and the progression of care by coordinating with multidisciplinary teams and ensuring the responsible, judicious allocation of high-cost resources.
Upholds Quality and Compliance: Mitigates regulatory risk by enforcing evidence-based clinical standards (e.g., InterQual) and ensuring compliance with all governmental and third-party payer regulations.
Responsibilities
- Secures Patient-Centered Care: Ensures the right care at the right time by validating medical necessity, advocating for benefits, and coordinating smooth, safe transitions to reduce readmissions.
- Maximizes Financial Health: Protects and maximizes organizational revenue by preventing claim denials, ensuring proper status designation for reimbursement, and managing the appeals process.
- Drives Operational Efficiency: Streamlines hospital workflows and the progression of care by coordinating with multidisciplinary teams and ensuring the responsible, judicious allocation of high-cost resources.
- Upholds Quality and Compliance: Mitigates regulatory risk by enforcing evidence-based clinical standards (e.g., InterQual) and ensuring compliance with all governmental and third-party payer regulations.
Requirements
- Licensure / Certification / Registration: Registered Nurse credentialed from the Oklahoma Board of Nursing obtained prior to hire date or job transfer date required.
- Education: Diploma from an accredited school/college of nursing OR Required professional licensure at time of hire.
Preferences
- 5+ years of Nursing experience
- Case Management or Utilization Management experience preferred
Benefits
Retirement: 403(b) plan
Well-being support: Employee Assistance Program, counseling and peer support, spiritual care and stress management resources