• Utilization Management Nurse

    Humana (Oklahoma City, OK)
    …part of our caring community and help us put health first** The SNF Utilization Management Nurse uses clinical knowledge, communication skills, and ... receives guidance where needed. Follows established guidelines and procedures. The SNF Utilization Management Nurse uses clinical knowledge, communication… more
    Humana (06/05/25)
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  • Utilization Management Nurse

    CVS Health (Oklahoma City, OK)
    …constituents in the coordination and administration of the utilization /benefit management function. Required Qualifications + Registered Nurse in state of ... years of Nursing experience. Preferred Qualifications + Prior authorization utilization management /review experience preferred Outpatient Clinical experience. +… more
    CVS Health (06/01/25)
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  • Utilization Management Nurse

    CVS Health (Oklahoma City, OK)
    …Must have active current and unrestricted RN licensure in state of residence. + Utilization Management is a 24/7 operation and work schedules will include ... med surg or specialty area. + Managed Care experience preferred, especially Utilization Management . + Preference for those residing in EST and CST zones.… more
    CVS Health (06/08/25)
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  • National Utilization Management

    Humana (Oklahoma City, OK)
    …a part of our caring community and help us put health first** The Utilization Management (UM) Director, Clinical Strategy and Practice for Medicaid builds ... of how organization capabilities interrelate across the function or segment. The Utilization Management (UM) Director, Clinical Strategy and Practice for… more
    Humana (06/06/25)
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  • AVP, Utilization Review & Pharmacy

    Zurich NA (Oklahoma City, OK)
    …+ Experience in development and implementation of cost containment programs + Case management , utilization review, catastrophic or disability experience + 5 or ... AVP, Utilization Review & Pharmacy 123092 Zurich Insurance is...recruiting and retaining team members. + Drive the performance management process by communicating job expectations, monitoring and evaluating… more
    Zurich NA (05/22/25)
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  • Appeals Licensed Practical Nurse

    Evolent (Oklahoma City, OK)
    …team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and client policies and ... the culture. **What You'll Be Doing:** The Evolent Appeals Nurse team offers candidates the opportunity to make a...and regulations. * Practices and maintains the principles of utilization management and appeals management more
    Evolent (05/16/25)
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  • Clinical Registered Nurse - Remote

    Sharecare (Oklahoma City, OK)
    …total healthcare management and ensure cost effective, appropriate resource utilization and quality outcomes. The Clinical Registered Nurse is also ... the participants and their Primary Care Provider according to the disease management program intervention guidelines. A Clinical Registered Nurse is supervised… more
    Sharecare (05/10/25)
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  • Transition of Care Coordinator Registered…

    CVS Health (Oklahoma City, OK)
    …monitors established plans of care to meet the member's goals. + Utilizes case management , utilization management , and quality management processes in ... per our company expense reimbursement policy. **Preferred Qualifications** + Managed care/ utilization review experience + Case management in an integrated… more
    CVS Health (06/06/25)
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  • Transplant Care Nurse RN - Stem Cell, Bone…

    Highmark Health (Oklahoma City, OK)
    …Nursing **EXPERIENCE** **Required** + 7 years in any combination of clinical, case/ utilization management and/or disease/condition management experience, or ... on where clinical care is being provided. **Preferred** + Certification in utilization management or a related field + Certification in Case Management more
    Highmark Health (04/25/25)
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  • Consultant, Nurse Disability

    Lincoln Financial (Oklahoma City, OK)
    …Care, Orthopedics, Coronary Care, , Trauma , Disability, Workman's comp or case management or Utilization review **Application Deadline** **What's it like to ... Role at a Glance** We are excited to bring on a highly motivated Nurse Disability Consultant to our clinical organization. This position will be responsible for… more
    Lincoln Financial (06/10/25)
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  • Appeals Nurse

    Evolent (Oklahoma City, OK)
    …team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and Client policies and ... **What You Will Be Doing:** + Practices and maintains the principles of utilization management and appeals management by adhering to company policies and… more
    Evolent (06/01/25)
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  • PRN Registered Nurse - Azura Outpatient…

    Fresenius Medical Center (Oklahoma City, OK)
    …direction of the Facility Manager, Director of Nursing and/or Charge Registered Nurse , utilizing standard nursing techniques to assist the physician in optimum ... on adverse events and action thresholds in collaboration with facility management . + Maintains integrity of medical records and other organization administrative… more
    Fresenius Medical Center (04/04/25)
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  • Regional Field Director, RNS Program…

    United Therapeutics (Oklahoma City, OK)
    …for which transplant is not currently an option. Who you are You are experienced nurse and an expert in all things PAH. You love providing mentorship, coaching and ... make a difference. The Regional Field Director, RNS Program Management serves as a director of all clinical field...+ Plan, collaborate, create and produce the yearly Clinical Nurse Summit meeting for HCPS across the United States… more
    United Therapeutics (06/05/25)
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  • Strategy Advancement Advisor

    Humana (Oklahoma City, OK)
    …**Key Functions:** **Strategic Planning and Implementation:** + Develop and implement utilization management strategies that align with organizational goals. + ... care. **Cost Containment:** + Identify opportunities for cost savings through effective utilization management practices. + Monitor and analyze utilization more
    Humana (06/06/25)
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  • CAR-T Field Operations Lead - South Central

    IQVIA (Oklahoma City, OK)
    …raising the bar on customer experience in the pharmaceutical industry. Our account management teams support the certified sites who care for cancer patients. We are ... care. The CAR-T Cell Therapy Experience Lead is a member of this account management team, reporting to the Senior Manager, CAR-T Cell Therapy Experience Lead. The… more
    IQVIA (05/24/25)
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  • RN - Case Manager - Weekends Only |

    SSM Health (Midwest City, OK)
    …opportunities for improvement in standard work. + May also be responsible for: utilization management process, ED case management process, admission process, ... Hospital Midwest **Worker Type:** Regular **Job Highlights:** **Department:** System Case Management **Schedule:** Scheduled two 12 hour shifts Saturday and Sunday… more
    SSM Health (06/03/25)
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  • Manager, UM Behavioral Health

    Humana (Oklahoma City, OK)
    …of our caring community and help us put health first** The Manager, Utilization Management Behavioral Health utilizes behavioral health knowledge and skills to ... of medical services and/or benefit administration determinations. The Manager, Utilization Management Behavioral Health works within specific guidelines… more
    Humana (05/30/25)
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  • Territory Manager - Oklahoma South Central

    ZOLL Medical Corporation (Oklahoma City, OK)
    …patients suffering from serious cardiopulmonary and respiratory conditions.ZOLL Cardiac Management Solutions offers a unique portfolio of novel technologies designed ... patients at risk of sudden cardiac death. + HFMS (https://cardiacdiagnostics.zoll.com/products/heart-failure-arrhythmia- management -system/) (Heart Failure Management system) is a… more
    ZOLL Medical Corporation (05/23/25)
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  • Senior Clinical Strategy Consultant

    Highmark Health (Oklahoma City, OK)
    …​ **SKILLS** + Deep Clincal Expertise -extensive knowledge of clinical, quality, care, utilization , high-cost claim, and population health management . Must be a ... in Business or Clinical field **LICENSES or CERTIFICATIONS** **Required** + Registered Nurse (RN) or Pharmacist (Pharm D) or Physician Assistant (PA) **Preferred** +… more
    Highmark Health (05/10/25)
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