- Humana (Oklahoma City, OK)
- …Coordinator or discharge planner in an acute care setting + Previous experience in utilization management/ utilization review for a health plan or acute care ... our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination,… more
- Saint Francis Health System (Tulsa, OK)
- …participates in the Patient Care Committee for patient care reviews, and in Utilization Review Staff Committee, providing data and contributing to improvement of ... administrative and clinical support to the hospital and treatment team throughout the review of patients, their placement in various levels of care and their receipt… more
- CVS Health (Oklahoma City, OK)
- …with transferring patients to lower levels of care. + 1+ years' experience in Utilization Review . + CCM and/or other URAC recognized accreditation preferred. + ... AHH is URAC accredited in Case Management, Disease Management and Utilization Management. AHH delivers flexible medical management services that support… more
- Highmark Health (Oklahoma City, OK)
- …**Job Description :** **JOB SUMMARY** This job implements effective complimentary utilization and case management strategies for an assigned member panel. Provides ... to appropriate resources for additional support. + Implement care management review processes that are consistent with established industry, corporate, state, and… more
- Evolent (Oklahoma City, OK)
- …the mission. Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior approvals. Tasks ... physician-developed medical policies, and clinical decision-making criteria sets. The Clinical Review Nurse serves as a member advocate, expediting care… more
- Saint Francis Health System (Muskogee, OK)
- …**to login and apply.** Full Time Days **Registered Nurse Fulltime Surgery** **Not currently accepting New Grad with ... move patients from bed to OR table \#RNSIND Job Summary: The Registered Nurse III assess, plans, implements and evaluates nursing care utilizing the nursing process… more
- Saint Francis Health System (Muskogee, OK)
- …**to login and apply.** Full Time Nights **Registered Nurse Full-time ICU** **Adult Intensive Care Unit** **6-12 months ... Registered Nurse experience required** Staff floats to other areas as...goals. Facilitates patient discharge through timely, appropriate referrals and utilization of patient education resources, suitable to patient age… more
- Saint Francis Health System (Muskogee, OK)
- …**to login and apply.** Full Time Days **Registered Nurse Full-time Outpatient Infusion** . **Not available for New ... challenges and changes Maintain a flexible mindset Job Summary: The Registered Nurse I assesses, plans, implements and evaluates nursing care, utilizing the nursing… more
- Saint Francis Health System (Muskogee, OK)
- …as needed by the department; limited benefit offerings. Variable **Registered Nurse ECB Geriatric Psych** Adult patients with dementia, depression, Alzheimer's, and ... 12-hour shift on each of 2 designated holidays Job Summary: The Registered Nurse I assesses, plans, implements and evaluates nursing care, utilizing the nursing… more
- Dispatch Health (Tulsa, OK)
- …a novel care model while helping reduce hospital admissions, decrease ER utilization , improve patient success, and increase the patient and provider experience. ... in the State of **OK** as a Licensed Registered Nurse or licensure from a state participating in the...from vial including flu solution and expiration date for review by facility. Vaccination received one (1) month prior… more
- Evolent (Oklahoma City, OK)
- …focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and Client policies and procedures ... work with a group of nurses, providing appeal intake review for one dedicated client. They interact with coordinators...Be Doing:** + Practices and maintains the principles of utilization management and appeals management by adhering to company… more
- Saint Francis Health System (Tulsa, OK)
- …*$10K Sign-on Bonus, per program guidelines \#RNSIND Job Summary: The Registered Nurse I assesses, plans, implements and evaluates nursing care, utilizing the ... Registration and/or Certification: Valid multi-state or State of Oklahoma Registered Nurse License. Work Experience: Minimum of 2 years of related experience… more
- Saint Francis Health System (Tulsa, OK)
- …and grow. Come join our team today! \#RNSIND Job Summary: The Registered Nurse I assesses, plans, implements and evaluates nursing care, utilizing the nursing ... Registration and/or Certification: Valid multi-state or State of Oklahoma Registered Nurse License. Work Experience: 0 - 6 months related experience. Knowledge,… more
- Saint Francis Health System (Tulsa, OK)
- …Registration and/or Certification: Valid multi-state or State of Oklahoma Registered Nurse License. Work Experience: 1 - 2 years related experience. Knowledge, ... disorders. Basic PC skills as required for electronic documentation and data review . Essential Functions and Responsibilities: Uses the nursing process and physician… more
- Evolent (Oklahoma City, OK)
- …the mission. Stay for the culture. **What You'll Be Doing:** The Nurse Practitioner/Physician Assistant (ARNP/NP/PA) Vascular Surgey is responsible for support and ... assistance for all cardiology administrative and clinical utilization management and quality improvement functions under the auspices of the office of the Chief… more
- Fresenius Medical Center (Ponca City, OK)
- …auditing activities. + Accountable for completion of the Annual Standing Order Review and Internal Classification of Disease (ICD) coding. + Manages clinic ... financials including efficient utilization of supplies or equipment and regular profits and...of supplies or equipment and regular profits and loss review . + Responsible for all required network reporting and… more
- Highmark Health (Oklahoma City, OK)
- …of the claim rejection and the proper action to complete the retrospective claim review with the goal of proper and timely payment to provider and member ... Payment Integrity strategies on a pre-payment and retrospective claims review basis. Review process includes a ...data to assure appropriate level of payment and resource utilization . It is also used to identify issues which… more
- Humana (Oklahoma City, OK)
- …to improve the lives of others. **Essential Duties and Responsibilities:** + Review PA requests for home health services, durable medical equipment, outpatient ... Medicaid criteria, iCare guidelines, and PA Department policies and procedures. + Review PA requests for inpatient medical stays, skilled nursing facility stays,… more
- Oracle (Oklahoma City, OK)
- …(ECD) alignments, Critical Care workflow implementation, Multi-Disciplinary Rounding, and various nurse chart review and documentation optimizations. The ideal ... sessions, and offer ongoing consultation to support user proficiency and system utilization . Monitor project outcomes, track key metrics, and report progress to… more