Oklahoma Licensed Utilization Management RN

Job Summary

Responsible for clinical review of utilization requests, the full-time Oklahoma Licensed Utilization Management RN will assess and implement coordination of care opportunities for high-risk members while working remotely as part of the Utilization Management Team.

Key responsibilities:

• Perform utilization review of outpatient, ancillary, inpatient, and post-acute services
• Determine medical necessity and appropriateness of services using clinical review criteria
• Collaborate with physicians and providers to facilitate service provision throughout the health care continuum

Required qualifications:

• Current, active, unrestrictive license to practice as a Registered Nurse in the State of Oklahoma
• Graduation from an accredited School of Nursing
• Three years of acute care experience preferred
• Two years of experience working with population health preferred
• Knowledge of managed care and associated group benefit plans