- Humana (Oklahoma City, OK)
- …a part of our caring community and help us put health first** The Weekend Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… 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 ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
- Cognizant (Oklahoma City, OK)
- …background - Registered Nurse (RN) . 2-3 years combined clinical and/or utilization management experience with managed health care plan . 3 years' experience ... Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact by performing advanced...care revenue cycle or clinic operations . Experience in utilization management to include Clinical Appeals and… more
- Lincoln Financial (Oklahoma City, OK)
- …and/or proficiency with Disability Management (STD/LTD) knowledge, Workers Compensation, Utilization Review and/or nurse case management preferred skills ... 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
- CVS Health (Oklahoma City, OK)
- …health setting required. + Strong knowledge of clinical practice guidelines and utilization management . **Required** **Qualifications** : + Unrestricted OK state ... your clinical skills to coordinate, document, and communicate all aspects of our utilization and benefit management programs. You'll apply critical thinking and… more
- Centene Corporation (Oklahoma City, OK)
- …28 million members as a clinical professional on our Medical Management /Health Services team. Centene is a diversified, national organization offering competitive ... Analyzes BH member data to improve quality and appropriate utilization of services + Provides education to providers members...Health Professional (LMHP) required or + RN - Registered Nurse - State Licensure and/or Compact State Licensure required… more
- CVS Health (Oklahoma City, OK)
- …Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers flexible medical management ... Abuse or Maternity/ Obstetrics experience. **Preferred Qualifications** + 1+ years' Case Management experience or discharge planning, nurse navigator or nurse… more
- Fresenius Medical Center (Oklahoma City, OK)
- **PURPOSE AND SCOPE:** The Inpatient Services Charge Nurse is an additional "responsibility" assigned to the Inpatient Services RN, for a limited period of time, and ... duties, as assigned by the Program Manager. The Inpatient Services Charge Nurse ensures appropriate provision of Acute Dialysis Services and treatments within… 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 ... within the first 6 months of employment. **Preferred** + Certification in utilization management or a related field + Certification in Case Management … more
- 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
- Highmark Health (Oklahoma City, OK)
- …timeframes and notification requirements are met. + Communicate effectively with Utilization Management Staff, providers, other internal and external customers ... Documents, processes and routes requests for services to the nurse reviewer and other departments based on documentation procedures,...and management . + Route Cases Based on Established Guidelines. +… more
- Veterans Affairs, Veterans Health Administration (Oklahoma City, OK)
- …this occupational series. For more information, refer to Required Documents below. The Nurse Wound Care Registered Nurse (RN) is responsible for providing ... all elements of the nursing process when providing and/or supervising the management of patients/residents with acute and chronic wounds across clinical practice… more
- 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:** The schedule for this role will be 8am-2pm (any… more
- 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, ... described in the department's Scope of Service. + As an SSM Health nurse , I will demonstrate the professional nursing standards defined in the professional practice… more
- Health Care Service Corporation (Oklahoma City, OK)
- …for supervising clinical staff involved in a variety of clinical operations such as Utilization Management , Case Management and/or Disease Management . ... Responsible for hiring, training, performance reviews, pay administration, change management and ensuring staff meet/exceeds goals and initiatives. Implement… more
- Sharecare (Oklahoma City, OK)
- …/ new hire plan selection, claims issues, ID card issues, grievances/appeals, utilization management (UM) status, including but not limited to medical, ... + Claims adjustments + Grievances and appeals submissions + Utilization management intake or status + Complex...and second opinion. + Referring members to Clinical Advocates ( Nurse ) for conditions that require clinical care and case… more