- ERP International (Tinker AFB, OK)
- …algorithms, CM software, and databases for community resources. - Integrate CM and utilization management (UM) and integrating nursing case management with ... **Overview** ERP International, LLC is seeking a **Registered Nurse - Case Manager** for a full-time position...2 years as a BSN full time experience in clinical case management working with adults, children,… more
- CVS Health (Oklahoma City, OK)
- …And we do it all with heart, each and every day. **Position Summary:** The ** Utilization Management Clinical Nurse Consultant - Prior Authorization** ... internal and external constituents in the coordination and administration of the utilization /benefit management function. + Gathers clinical information and… more
- Cognizant (Oklahoma City, OK)
- …. Educational background - Registered Nurse (RN) . 2-3 years combined clinical and/or utilization management experience with managed health care plan ... 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 … more
- Humana (Oklahoma City, OK)
- …of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, ... determination of the appropriate courses of action. The Utilization Management Nurse 2 uses clinical knowledge, communication skills, and independent… more
- CVS Health (Oklahoma City, OK)
- … (UM) Nurse Consultant. As a Utilization Management Nurse Consultant, you will utilize clinical skills to coordinate, document and communicate all ... and state regulated turn-around times. This includes reviewing written clinical records. **Key Responsibilities of the UM Nurse...practice experience as an RN required. + 2+ Years Utilization Management experience. + Must be willing… more
- CVS Health (Oklahoma City, OK)
- …a psychiatric or behavioral health setting required. + Strong knowledge of clinical practice guidelines and utilization management . **Required** ... clinical skills to coordinate, document, and communicate all aspects of our utilization and benefit management programs. You'll apply critical thinking and… more
- US Tech Solutions (May, OK)
- …HAVE MANAGED CARE exp and Medicare/Medicaid knowledge. . MUST HAVE UM experience, inpatient utilization management review. . MUST HAVE 1 YEAR OF UTILIZATION ... and evaluates Potential Quality of Care issues based on clinical policies and benefit determinations. . Considers all documented.... 1+ years of inpatient hospital experience . Registered Nurse in state of residence . Must have prior… more
- CVS Health (Oklahoma City, OK)
- …internal and external constituents in the coordination and administration of the utilization /benefit management function. + Gathers clinical information and ... skills to coordinate, document, and communicate all aspects of the utilization /benefit management program. + Applies critical thinking and knowledge in… more
- CVS Health (Oklahoma City, OK)
- … skills to coordinate, document and communicate all aspects of the utilization /benefit management program. Applies critical thinking and is knowledgeable in ... and external constituents in the coordination and administration of the utilization /benefit management function. **Required Qualifications** + 3+ years post… more
- Saint Francis Health System (Tulsa, OK)
- …Licensure, Registration and/or Certification: Valid multi-state or State of Oklahoma Registered Nurse License, or Clinical Social Worker (LCSW), or Professional ... 8:00am - 12:00pm **OR** 1:00pm - 5:00pm Job Summary: Provides administrative and clinical support to the hospital and treatment team throughout the review of… more
- Evolent (Oklahoma City, OK)
- …for the mission. Stay for the culture. **What You'll Be Doing:** The Nurse Reviewer is responsible for performing precertification and prior approvals. Tasks are ... independent nursing judgement and decision-making, physician-developed medical policies, and clinical decision-making criteria sets. Acts as a member advocate by… more
- Fresenius Medical Center (Ponca City, OK)
- **About this role:** As a Clinical Manager with Fresenius Medical Care, you will ensure that quality patient care is delivered while maintaining clinical ... or chronic kidney disease. **Training and advancement:** You will enter our Clinical Leadership Program that creates and supports a culture of continuous learning… more
- Sharecare (Oklahoma City, OK)
- …helps to drive cost effective and appropriate resource utilization and desired clinical outcomes. The Disease Management Nurse is also responsible during ... for everyone. To learn more, visit www.sharecare.com . **Job Summary:** The Disease Management Nurse has the responsibility for supporting the goals and… 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 ... self-insured clients. + Application and/or interpretation of applicable criteria and clinical guidelines, standardized care management plans, polices, procedures… more
- Veterans Affairs, Veterans Health Administration (Muskogee, OK)
- …thinking skills. Possessing intimate knowledge of the internal referral care process, clinical review criteria, utilization management standards, clinical ... Veterans Act of 2016. Responsibilities The Community Care (CC) Coordinator Registered Nurse (RN) is responsible for executing a streamlined approach to receiving,… more
- Highmark Health (Oklahoma City, OK)
- …Degree in Nursing **EXPERIENCE** **Required** + 7 years in any combination of clinical , case/ utilization management and/or disease/condition management ... panel of members that range in health status/severity and clinical needs; and assesses health management needs...first 6 months of employment. **Preferred** + Certification in utilization management or a related field +… more
- Humana (Oklahoma City, OK)
- **Become a part of our caring community and help us put health first** The Appeals Nurse 2 resolves clinical complaints and appeals. The Appeals Nurse 2 work ... Office products including Word, Excel and Outlook **Preferred Qualifications** + Utilization Review/Quality Management experience + Experience working with MCG… more
- Saint Francis Health System (Muskogee, OK)
- …Knowledge, Skills and Abilities: Working knowledge of general disease state management processes, bio-psychosocial model, and clinical pathways. Effective ... (http://www.myworkday.com/saintfrancis/d/task/3005$4482.htmld)** **to login and apply.** Full Time Nights **Registered Nurse Full-time ICU** **Adult Intensive Care Unit** **ICU experience… more
- Saint Francis Health System (Tulsa, OK)
- …error, and support decision-making. Working knowledge of general disease state management processes, bio-psychosocial model, and clinical pathways. Ability to ... weekends Minimum of 5 years bedside experience preferred. Virtual Nurse works from an on-site office location (not a...be detail oriented as required in the examination of clinical and numerical data. Ability to demonstrate comfort and… more
- Saint Francis Health System (Muskogee, OK)
- …Knowledge, Skills and Abilities: Working knowledge of general disease state management processes, bio-psychosocial model, and clinical pathways. Effective ... month as needed by the department; limited benefit offerings. Nights **Registered Nurse ECB Women's Services** Registered Nurse Experience required **36 hours… more
