- Parexel (Oklahoma City, OK)
- **Job Title:** Data Management Lead (Medical Affairs) - Oncology **Location:** Fully Remote (US based) Must be able to accommodate West Coast hours. **About Us:** At ... solutions. We are seeking a dynamic and experienced Data Management Lead to join our team. If you have...practices like version control and literate programming. + BSN, RN , RPh, Pharm D, PA, MPH, or other applicable… more
- ERP International (Tinker AFB, OK)
- **Overview** ERP International, LLC is seeking a ** Registered Nurse - Case Manager** for a full-time position supporting **SHG Clinic** in support of **Tinker ... and databases for community resources. - Integrate CM and utilization management (UM) and integrating nursing case...or pending adverse actions) to practice nursing as a registered nurse in any US state/jurisdiction. Security**… more
- CVS Health (Oklahoma City, OK)
- …+ Active and good standing Arizona clinical and/or counseling license, specifically RN ( Registered Nurse ), LPC (Licensed Professional Counselor), LAC ... experience working within the mental health system. + Previous experience with utilization management . + Ability to collaborate with various internal… more
- Humana (Oklahoma City, OK)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work...skills to make an impact** **Required Qualifications** + **Licensed Registered Nurse ( RN )** in the… more
- CVS Health (Oklahoma City, OK)
- …active current and unrestricted RN licensure in state of residence - Utilization Management is a 24/7 operation and work schedules will include weekends, ... **Required Qualifications** - 2+ years of experience as a Registered Nurse in adult acute care/critical care...or specialty area - Managed Care experience preferred, especially Utilization Management - Preference for those residing… more
- Humana (Oklahoma City, OK)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work...skills to make an impact** **Required Qualifications** + Licensed Registered Nurse ( RN ) in the… more
- CVS Health (Oklahoma City, OK)
- …: + Unrestricted OK state independent Behavioral Health clinicianlicense or a Registered Nurse ( RN ) with psychiatric specialty,certification, or Behavioral ... to coordinate, document, and communicate all aspects of our utilization and benefit management programs. You'll apply...Health licensure (LCSW, LPCC, LMFT, LPAT, LP) or a Registered Nurse ( RN ) with unrestricted… more
- Cognizant (Oklahoma City, OK)
- …have to be considered** . Educational background - Registered Nurse ( RN ) . 2-3 years combined clinical and/or utilization management experience with ... Eastern Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact...care revenue cycle or clinic operations . Experience in utilization management to include Clinical Appeals and… more
- CenterWell (Oklahoma City, OK)
- …clinical experience. + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Intelligence + ... put health first** Conviva Care Solutions is seeking a RN who will collaborate with other health care givers...Experience with Home Health preferred + Previous experience in utilization management within Insurance industry a plus… more
- CVS Health (Oklahoma City, OK)
- …and timely discharge, appropriate follow-up care, and next steps. + Coordinate with the Utilization Management team to review medical and payer records to ensure ... stay and identify any barriers to discharge. + Assist Utilization Management team with access to external...**What are we looking for?** **Required Qualifications** + Active RN license in good standing within the state of… more
- CVS Health (Oklahoma City, OK)
- …is subject to change based on business needs. **Preferred Qualifications** 6+ months Case Management or Utilization Management experience Case Management ... however, it is subject to change based on business needs.** The RN Case Manager is responsible for telephonically assessing, planning, implementing, and coordinating… more
- Select Medical (Oklahoma City, OK)
- … within the plan of care. + Demonstrates compliance with facility-wide Utilization Management policies and procedures. + Coordinates UR compliance with ... current licensure in a clinical discipline either as a Nurse ( RN /LPN/LVN) or a Respiratory Therapist (RT)...what is right. The Case Manager is responsible for utilization reviews and resource management , discharge planning,… more
- SSM Health (Midwest City, OK)
- …Illinois Department of Financial and Professional Regulation (IDFPR) State of Work Location: Missouri + Registered Nurse ( RN ) Issued by Compact State + Or + ... in standard work. + May also be responsible for: utilization management process, ED case management...Registered Nurse ( RN ) - Missouri Division of Professional… more
- Veterans Affairs, Veterans Health Administration (Oklahoma City, OK)
- Summary The Veterans Affairs Oklahoma City Health Care System is seeking a Registered Nurse / Nurse Manager for Nursing, Ambulatory Care providing or ... for the coordination of care focused on patient education, self- management , and customer satisfaction throughout the continuum of care....level degree in Nursing may have opportunity to become registered as a nurse with a state… more
- 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 ... in addressing targeted populations **LICENSES or CERTIFICATIONS** **Required** + RN license in PA or WV or DE or...first 6 months of employment. **Preferred** + Certification in utilization management or a related field +… more
- Highmark Health (Oklahoma City, OK)
- …and education or if necessary involve Special Investigation Unit or the Utilization Management area. **ESSENTIAL RESPONSIBILITIES** + Implement the pre-payment ... data to assure appropriate level of payment and resource utilization . It is also used to identify issues which...experience in Managed Care **LICENSES or CERTIFICATIONS** **Required** + Registered Nurse **Preferred** + Certified Medical Coder… more
- CVS Health (Oklahoma City, OK)
- …+ 5-7 years of regulatory and/or clinical audit experience. + Experience in medical management , including Utilization Management (UM) and Case Management ... accreditation processes, and NCQA standards. + Licensed clinical professional ( RN preferred). + Excellent analytical, organizational, and communication skills. +… more
- Evolent (Oklahoma City, OK)
- …responsible for support and assistance for all cardiology administrative and clinical utilization management and quality improvement functions under the auspices ... in a regulatory role (preferred). **LICENSE/CERTIFICATION:** Current, unrestricted state PA or RN /NP license in medicine or required specialty. Of a PA, obtaining a… more
- Select Medical (Oklahoma City, OK)
- **Overview** Nurse Manager- Registered Nurse ( RN ) Full-Time Days **Select Specialty Hospital-Oklahoma City** is a critical illness recovery hospital ... of the most vulnerable, painful moments of their lives - and the Nurse Manager plays a central role in providing compassionate, excellent treatment and leadership… more
- Datavant (Oklahoma City, OK)
- …job function as delegated by management Ideal candidate should be a Licensed Practical Nurse or Registered Nurse well versed in DRG downgrade denials and ... of the Denial Prevention Specialist is to effectively defend utilization of available health services, review of admissions for...expertise successfully. Ideal candidate should be a Licensed Practical Nurse or Registered Nurse well… more
